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Future Forum interim advice: RCP positions on integration and information

As the Future Forum presents interim advice to the Secretary of State for Health today, please see below for the RCP’s positions on both integration and information. The RCP has today submitted its evidence to the Future Forum workstream on integrated care.

RCP position on integration

The RCP welcomes the emphasis on the importance of integrated care, which considers patients’ needs. In order to achieve this, we need a system which better incentivises and rewards clinicians to work together to deliver services centred around the needs of patients. The RCP agrees with the Future Forum that the existing health service payment structures often act as a barrier to integrated care. The Future Forum advises that tariff ‘flexibilities’ should be applied in order to allow the development of new models of care. Crucially, these flexibilities should only be applied to new models of care that promote integration, collaboration and quality; flexibilities in the tariff must not be used to drive down price and service quality.

A summary of the RCP's submission to the Future Forum workstream on integration:

  • The RCP advocates a care system in which traditional professional boundaries are broken down so that health professionals can manage patients using integrated care pathways designed by local clinicians, working collaboratively with patients.
  • Integrated working allows patients and their carers to benefit from specialist knowledge (including early referral for more specialist opinions and diagnostic tests when needed), the general care provided by GPs and primary care teams, and the help and support provided by those working in social care.
  • If we are to achieve more integration of health and social care services, it will be crucial that the new healthcare commissioning arrangements fully involve a range of health, public health and social care professionals.  The RCP advocates a ‘commissioning without walls’ model. Patients must also be empowered and enabled to be involved fully in commissioning and strategic decisions.
  • Needs would be better met if we moved to a tariff structure that better reflected clinical complexity; we welcomed the commitment to this in the government’s response to the Future Forum’s report. The current tariff structure over-compensates for simpler conditions and consistently under compensates for more complex and unpredictable areas of care. In order to encourage integrated working, consideration should be given to moving towards a system in which payments are received, not for single episodes of care, but over the longer term (eg annually or by pathway). The RCP advocates tariffs that reflect pathways, and for chronic conditions, annual tariffs for blocks of care.
  • Regulation needs to look across institutions and consider care pathways, and needs to be better joined up with local authority scrutiny processes.

RCP position on information

The RCP agrees with the Future Forum’s emphasis on the importance of information in the health service, and the accessibly of the information to patients and across service boundaries, to ensure patients receive holistic, coordinated care and support them to make informed decisions. The RCP also agrees that data collection should be integral to patient care, not a bureaucratic burden. In order to achieve this we need to revolutionise the information we collect, using common record standards, and the information gathered must be clinically useful.

A summary of the RCP’s submission to the Future Forum workstream on information:

  • The development of evidence and consensus-based national standards for electronic records is essential. Electronic health records (EHRs) must be structured upon standards that reflect best clinical practice and support the way that clinicians work with patients. It is a necessary and efficient investment to ensure that information is comparable through time and across providers.  The RCP urges government to prioritise the further development of professional record standards.
  • The RCP recommends that we move to an information system that:
    • gathers standardised person-level data and develops a single person-level record
    • embeds clinical standards into data collection and quality indicators
    • revises requirements for data collection so that they focus on clinically valuable information derived from the basic building block of health care: the patient-professional interaction
    • ‘mainstreams’ the collection of information on patient experience and perspectives
    • integrates records and enables data sharing, comparison and integration across providers boundaries and specialties
    • incorporates the universal introduction of standards for the structure and content of records
    • reforms the process of central returns from hospitals so that these cover both inpatient and ambulatory episodes, contain more detailed clinical content, and are directly derived from clinical data collected in standardised, structured, coded form at the point of care
    • introduces standardised measures of patients’ health and social function into clinical records to enable monitoring of outcome and quality of care for people with chronic and long-term conditions across care settings, including care homes.
  • The RCP supports the E-Health Insider (EHI) campaign calling for the appointment of a chief clinical information officer (CCIO) in all NHS provider organisa­tions.

The RCP has also submitted evidence to the Future Forum on: