JANUARY

What is being done to promote delivery system integration and
care coordination?
ENGLAND
GPs increasingly work in multipartner practices that employ nurses and other clinical staff, who carry out much
of the routine monitoring of patients with long-term conditions. These practices also have some of the features
of a medical home—that is, they direct patients to specialists in hospitals or to community-based professionals,
like dieticians and community nurses, and hold treatment records of their patients. GPs are responsible for care
coordination as part of their overall contract; to improve coordination for older patients, the latest version of the
contract (2014–15) requires practices to have a “named accountable GP” for all patients over age 75. GPs also
have financial incentives to provide continuous monitoring of patients with the most common chronic
conditions, such as diabetes and heart disease.
The 2012 Act charged NHS England, Monitor, and CCGs with promoting integrated care—closer links between
hospital- and community-based health services, including primary and social care. The health and well-being
boards within local authorities are intended to promote integration between NHS and local authority services,
particularly at the intersection of hospital and social care.
The government announced in 2013 the selection of 14 “Pioneer” integration pilot programs, aimed at
improving coordination of health and care services for patients most at risk of having to undergo unplanned
or emergency treatment. The Better Care Fund provides GBP3.8 billion (USD5.4 billion), pooled from existing
health and social care budgets, for integration projects by local health and social care commissioners starting
in 2015–16. Health and well-being boards have submitted plans for these funds with a range of objectives,
including a reduction in emergency hospital admissions by 3.5 percent (Local Government Association, 2013).
What is the status of electronic health records?
The NHS number assigned to every registered patient serves as a unique identifier. Most general practice
patient records are computerized. Some practices use electronic systems to allow patients to make
appointments or email their GP, but there is no requirement for practices to have that capability. Records are
not routinely linked between providers.
A move to make primary, urgent, and emergency care services paperless by 2018, and all other parts of the
NHS by 2020, is being enforced by requirements that NHS organizations show progress toward that end in
the intervening years; they risk having funding removed if universal digital care records are not implemented
by 2020.
NHS Choices will serve as a single point of access for patients to register with a GP, book appointments and
order prescriptions, access apps and digital tools, speak to their doctor online or via video link, and view their
full health record (Department of Health 2014c). All NHS patients have the right of access to their own health
records (in some cases it is possible electronically) and can apply in writing to have a copy of their records held
by their general practice, hospital, or dentist. By 2016, all patients will be able to have access to their GP
electronic record in full, and by 2018 it is hoped that access will extend to data from all health and health
care interactions.
Electronic transfers are widely used by GPs to send prescriptions to pharmacies, and for the storage and
distribution of digital scans, X-rays, and other images.
NHS England has been developing a program for collecting data and for linking electronic records from general
practice with those from hospitals and other care settings, for purposes of research and planning in health and
social care services (NHS England, 2014b). Full implementation has been delayed because of concerns about
confidentiality, but piloting in 265 general practices started in 2014.
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