Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity

BMC Primary Care | Volume 24, Article number: 98 (April 2023) | https://doi.org/10.1186/s12875-023-02050-4

Chronic disease management is important in primary care. Disease management programmes focus primarily on the respective diseases. The occurrence of multimorbidity and social problems is addressed to a limited extent. Person-centred integrated care (PC-IC) is an alternative approach, putting the patient at the centre of care. This asks for additional competencies for healthcare professionals involved in the execution of PC-IC.

This scoping review researched which competencies are necessary for healthcare professionals working in collaborative teams where the focus lies within the concept of PC-IC. It also explored how these competencies can be acquired.

Four core competencies were identified: 1. interprofessional communication, 2, interprofessional collaborative teamwork, 3. leadership and 4. patient-centred communication.

Full paper: Michielsen, L., Bischoff, E.W., Schermer, T. et al. | Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity: Results of a scoping review

Integrated Care Systems: autonomy and accountability

The House of Commons Health & Social Care Committee’s report into new partnerships aimed at delivering joined-up health and care services is calling for the Government and NHS England to address key concerns if an opportunity to deliver real change is to be realised.

The inquiry, with a focus on autonomy and accountability, found genuine enthusiasm for the potential of ICSs to deliver on challenges facing the health and care sectors. However, MPs warn of a serious lack of clarity in some areas with risks that acute short-term pressures could be given priority over longer term ambitions such as preventing ill-health.

MPs also express concern that the success of the restructuring programme could be jeopardised if NHS England continued to take a “command and control” approach. The Report says it is vital that the Government and NHS England should not dictate how ICSs deliver local outcomes.

Full report: Integrated Care Systems: autonomy and accountability

Report summary: Integrated Care Systems: autonomy and accountability

See also: Urgent action needed to ensure opportunities of new health care restructure are realised, warn MPs

Preventing and managing frailty in older people

Joining the dots: A blueprint for preventing and managing frailty in older people | British Geriatrics Society

The population of the UK is ageing, with particularly fast growth in the oldest old age groups – by 2045, the number of people aged 85 and above will have almost doubled. In addition, older people are the largest user group of health and social care services. It is therefore essential that commissioners place older people and their health and social care needs at the centre of strategic planning and commissioning processes.

This publication is aimed primarily at system leaders and commissioners of health and social care services for older people, and sets out considerations for planning and commissioning health and social care for older people, alongside actions for systems to create the conditions for high-quality integrated care.

Full document: Joining the dots: A blueprint for preventing and managing frailty in older people

Summary document: Joining the dots: A blueprint for preventing and managing frailty in older people

Realising the potential of community-based multidisciplinary teams

The Health Foundation

Better integration between health and social care services is a longstanding policy objective in England and other countries. A common approach is the development of community-based multidisciplinary teams (MDTs), in which a mix of health and care professionals come together to plan and coordinate people’s care.

Despite widespread policy support, evidence on the impact of community-based MDTs is limited and mixed. This briefing summarises evidence from Improvement Analytics Unit (IAU) evaluations of three MDTs and wider evidence to inform current efforts to develop integrated care in England. It reflects on what this evidence means for local leaders looking to implement MDTs, as well as for national leaders seeking to support these models of integrated care.

Full briefing: Realising the potential of community-based multidisciplinary teams. Insights from evidence

Introducing Integrated Care Systems

House of Commons Public Accounts Committee

Integrated Care Systems (ICSs) are the latest attempt to bring NHS and local government services together, to improve services and health outcomes for people in their area. ICSs have the potential to improve the health of the populations they serve by better joining up services and focussing more on longer-term actions and preventative measures to address the causes of ill-health. However, this report suggests they will not succeed unless the Department of Health and Social Care addresses the multiple longstanding challenges facing the NHS and social care, which remain unresolved.

These include an elective care backlog which recently breached seven million cases for the first time, high workforce vacancy rates in both the NHS and social care, increasing demand, a crumbling NHS estate, and a very difficult financial outlook. Until the Department of Health and Social Care has properly addressed these issues, the report states that it is difficult to see how ICSs can fulfil their potential.

• Full report: Introducing Integrated Care Systems
• Report Summary: Introducing Integrated Care Systems
• Press release: Latest NHS reforms will not succeed until Government fixes longstanding problems

People, partnerships and place: How can ICSs turn the rhetoric into reality?

via Nuffield Trust

Integrated care systems are now legally responsible for leading the charge on using a localised approach to bring multiple aspects of the health care system closer together, and for working better with social care and other public services. But this is far from a new aspiration – why should it be any different this time? Nuffield Trust hosted a series of roundtables to discuss concerns with stakeholders and experts and understand how to ensure the aims are achieved. This new report consolidates these findings and offers ways forward as the new era gets underway.

Full briefing: People, partnerships and place: How can ICSs turn the rhetoric into reality? | Buckingham H, Reed SJ, Kumpunen S and Lewis R | Nuffield Trust

Integrating Care: policy, principles and practice for places

Chartered Institute of Public Finance and Accountancy (CIPFA)

This report provides an overview of the changes since the Health and Care Act 2022 was introduced and discusses what integration is seeking to achieve. It considers the wider health and care landscape in the current climate and addresses the remaining challenges at place level.

The recommendations and case studies it contains are intended to influence the development of further policy and guidance by central government, and to provide support for practitioners at local level. The purpose of the report is to help health and local government partners to find effective solutions to the challenges of health and care integration.

Full report: Integrating Care: policy, principles and practice for places

Press release: CIPFA publishes integrating care report

How the oversight and governance of integrated care systems (ICSs) can best enable them to succeed

Hewitt review: terms of reference | Department of Health and Social Care

The Hewitt review will consider how the oversight and governance of integrated care systems (ICSs) can best enable them to succeed, balancing greater autonomy and robust accountability with a particular focus on real time data shared digitally with the Department of Health and Social Care, and on the availability and use of data across the health and care system for transparency and improvement. This sets out the terms of reference for the review.

In particular the independent review of integrated care systems will consider and make recommendations on:

• how to empower local leaders to focus on improving outcomes for their populations, giving them greater control while making them more accountable for performance and spending
• the scope and options for a significantly smaller number of national targets for which NHS ICBs should be both held accountable for and supported to improve by NHS England and other national bodies, alongside local priorities reflecting the particular needs of communities
• how the role of the Care Quality Commission (CQC) can be enhanced in system oversight

Full detail: Hewitt review: terms of reference

See also: Hewitt review: call for evidence

Independent review of integrated care systems

Review will explore how best to cut through red tape and boost efficiency, financial accountability and autonomy, with fewer national targets | Department of Health and Social Care

The government has announced a new independent review into oversight of ICSs to reduce disparities and improve health outcomes across the country. The review will explore how to empower local leaders to focus on improving outcomes for their populations. This includes giving them greater control and making them more accountable for performance and spending, reducing the number of national targets, enhancing patient choice and making the healthcare system more transparent.

Further detail: Independent review of integrated care systems

Under pressure: an analysis of primary care pressures facing Integrated Care Systems at launch

New analysis published by Future Health identifies 16 of 42 regions where primary and secondary care services are under high levels of pressure going into this winter.

Analysis from 9 different NHS data sources including appointment access, waiting times and ratios of staff to patients is used to look at relative pressures between new Integrated Care Systems (ICSs). The research finds widespread variation in access to services including a nearly four-fold variation in the proportion of patients waiting three weeks or more for a GP appointment.

Key findings include:

• 16 of the 42 new ICSs are under relatively high levels of pressure across both primary and secondary care
• Of these 16, the 5 health systems under the most pressure are Bedfordshire Luton & Milton Keynes; Kent & Medway; Leicester, Leicestershire & Rutland; South Yorkshire; and Sussex
• Also included are areas with higher levels of deprivation in the Midlands and the North: Cumbria and Northeast, Lincolnshire, Nottingham and South Yorkshire and Bassetlaw

Full report: Under pressure: an analysis of primary care pressures facing Integrated Care Systems at launch

Press release: New Future Health research identifies the NHS regions under most pressure this winter