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Integration and Innovation: working together to improve health and social care for all


Blog headlines

  • Cultural change at the heart of integrated care systems
    8 April 2021

    The blog this week, by Helen Northall, looks at the changes needed to make integrated care systems a reality.

  • Bluelight Cycling Club
    1 April 2021

    We are a cycle club that is dedicated to the Police Service, Fire Service , NHS, Coastguard, RNLI, Prison Service, NCA, Search and Rescue community and Armed Forces.

  • Enabling Integrated End of Life Care with a population data dashboard
    25 March 2021

    The guest blog this week is by Dr Karen Chumbley MBBS FRCGP MSc, North East Essex Health and Wellbeing Alliance Lead for End of Life Care.

  • The new proposed NHS legislation and where this fits in the jigsaw of changes
    18 March 2021

    In the blog this week William Greenwood, chief executive of Cheshire Local Medical Committee, looks at the implications of the White Paper on general practice.

  • Integration and Innovation: working together to improve health and social care for all
    11 March 2021

    Professor David Colin-Thomé shares his thoughts on the White Paper in this week’s blog.

  • UK’s National Health Service teams up with the Radio Society of Great Britain to improve health and wellbeing
    4 March 2021

    This week's blog is by Paul Devlin, Emergency Care Improvement Support Team (ECIST), NHS England and NHS Improvement.

  • Structuring a PCN Social Prescribing Service for the post COVID world
    25 February 2021

    This week we have a blog by Nick Sharples.

  • Community-Oriented Integrated Care
    18 February 2021

    The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

  • Strategy Unit releases opensource model for planning vaccine centre capacity
    11 February 2021

    This week's blog is from The Strategy Unit who are sharing an opensource model to help with vaccine centre capacity planning.

  • Time to talk day
    4 February 2021

    A small conversation about mental health has the power to make a big difference.

  • Supporting Staff: the emergence of ‘long-covid’
    28 January 2021

    As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.

  • Link of the week: Clinically-Led workforce and Activity Redesign (CLEAR)
    21 January 2021

    This week we are sharing a link to the Clinically-Led workforce and Activity Redesign (CLEAR) site that is funded by Health Education England.

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

Thursday, 11 March 2021

Integration and Innovation: working together to improve health and social care for all

Professor David Colin-Thomé shares his thoughts on the White Paper in this week’s blog.

I support the overarching aim of this White Paper well described in its title. I quote from the White Paper; ‘This paper sets out the legislative proposals for a Health and Care Bill. It aims to build on the incredible collaborations we have seen through Covid-19 and shape a system that is better able to serve people in a fast-changing world. At its heart, however, this Bill is about backing our health and care system and everyone who works in it. Our proposals build on the NHS’s own – those in the Long Term Plan.

Indeed, what is there to oppose? My fear is that though the aims are laudable, the words encouraging and the thinking progressive, we do not have even as a beginning, an NHS culture that is enabling of such a vision. Of course the White Paper rightly embraces beyond heath care but the sheer magnitude of the NHS can dominate if it so wishes.

Let me describe the context as I see it. Apart from the present incumbent Simon Stevens and to some extent Duncan Nichol (I go back a long way), no NHS CEO has shown any real understanding of or desire for a community based focus to the NHS. This despite it being the site for most of healthcare and more importantly if the pursuit of health and wellbeing is to be of any real meaning, where the community is. An area of contention in the White Paper is giving politicians a return to a bigger say in the running of the NHS. On this I am surprising ambivalent. In primary care since 1990 we have benefited in general from political leadership in particular Conservative leadership. Fund Holding being the ‘Jewel in the Crown’ as it devolved power and leverage to primary care clinicians, a hitherto un-heard of concept. New Labour struggled and failed with politically acceptable alternatives.

The centre piece of the White Paper is the Integrated Care System (ICS) around which are centred the hopes and aspirations of those who wish the delivery of what is promised. Its planned governance structure is sensible, ‘Statutory ICSs, made up of an ICS NHS Body and an ICS Health and Care Partnership (together referred to as the ICS).This dual structure recognises that there are two forms of integration which will be underpinned by the legislation: the integration within the NHS to remove some of the cumbersome barriers to collaboration and to make working together across the NHS an organising principle; and the integration between the NHS and others, principally local authorities, to deliver improved outcomes to health and wellbeing for local people.’

A White Paper that promises much but a prevailing NHS culture that is over focused on hospitals, a top down hierarchical mode of leadership and favours big is beautiful will not be the enabler of the stated aspirations the country needs. Who can lead is the big question? And in what style of leadership?

Will the big beasts in the NHS define integration to produce the biggest provider capture ever with less choice and responsiveness? Integration will only mean something if the individual patient can feel the benefit. For the wider community can they perceive the ICS as the New Zealand Prime Minister describes her country- a team of 5 million people? it is worth revisiting Philip Gould - ‘…must find a way of integrating the schism between the individual as consumer and the individual as citizen’. A challenge to NHS thinking as in any NHS ‘pyramid’ denoting influence, power and resource availability, hospitals would be at the top, lip service to a primary care led NHS and patients and the public at or near the bottom. In the NHS and for the community and the individual can we through the ICS deliver on those aspirations. If not it will be only yet another structural change which the authors of the White Paper certainly do not intend. It must be about the leadership and choosing new types of positional leaders and creating a culture of a dispersed leadership even beyond the professionals. As Disraeli ‘Next to knowing when to seize an opportunity, the most important thing in life is to know when to forgo an advantage’. Not a common NHS feature.

Primary Care hitherto virtually excluded from system leadership has much to offer in talent and an experience of localism and working within the community. The ICS is proclaimed as the necessary devolution the NHS requires but they are still large in population size and many of its constituent organisations and essentially distant from its community. And to whom we devolve often become the new centralists. We must systematically adopt the concept of concomitantly being ‘big and little’ as localism matters. Governance should major on behaviours rather than the over weening obsession with compliance and embrace subsidiarity. And the value of the ICS recognised by its community, then we might just have the ICS we need.