Prof Chris Ham
Parliament debate: Public Bill CommitteeChris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."
“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”
Kaiser Permente Model:
Integration The most distinctive feature of the KP model is the way in which it integrates care:
Integrated inpatient and outpatient care enables patients to move easily between hospitals and the community, or into skilled nursing facilities should this be needed.
Medical specialists are not tied to a particular building – such as a hospital – but provide care in the most appropriate setting. Specialists work alongside generalists in multi-speciality medical groups that help communication between physicians. There is no incentive to build up facilities and resources at the expense of other settings.
Integrated prevention, diagnosis, treatment and care. A high priority is attached to keeping people healthy and avoiding the use of hospital services. Chronic disease management programmes, where care is delivered within the framework mentioned above, help ensure that care is provided as close to home as possible. Doctors have fast access to diagnostic services in the outpatient setting and practice from relatively large medical centres where diagnostic and other equipment is easily accessible.