Vertical Integration has protected some GP practices from closing down says new study

Primary Care Network 2 Inside
The research looked at the rationale for and early impact of vertical integration in the NHS in England and Wales.

In several places in the UK, GP practices are now being run by NHS hospitals, enabling some GP practices to continue that would otherwise have closed, says a new study by the National Institute for Health Research (NIHR) undertaken by researchers at the University of Birmingham and RAND Europe.

Otherwise known as vertical integration, having organisations managing NHS hospitals take over the operation of GP practices means that patients can continue to consult a range of health care professionals at the local practice rather than seeking healthcare elsewhere.

'The Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation', a study funded by the NIHR Health Services and Delivery Research (HS&DR) Programme, researched the rationale for and early impact of vertical integration in the National Health Service (NHS) in England and Wales.

The authors found that without vertical integration, at least some GP practices would have been forced to close down, which would have increased the pressure on remaining practices in the vicinity and forced patients to travel further to receive care. By interviewing GPs, NHS managers, and other staff, 52 people in all, at two locations in England and one in Wales, the evaluation concluded that through vertical integration these practices were also increasingly able to offer patients the opportunity to consult a range of health care professionals at the local practice, not just GPs, but also staff with special training to provide specific types of health care, for example, for diabetes or for problems with joint pain.

An important benefit to efficiency is the scope for better management of emergency patient flows to acute hospitals. The authors plan to return to the question of costs and savings, patient experiences and outcomes, in a future evaluation of vertical integration.

Dr Manbinder Sidhu, report co-author commented: "The single most important driver of hospitals and health boards managing general practices proved to be the maintenance of primary care local to where patients live. The opportunities created by vertical integration’s successful continuation of primary care – namely, to develop patient services in primary care settings and better integrate them with secondary care – were exploited to differing degrees across the three sites to address the staffing, workload and financial difficulties faced by some GP practices."

The evaluation also concluded that vertical integration succeeded where there were good pre-existing relationships between primary and secondary care, and where key individuals were active in providing leadership, energy and focus for the integration. Recruitment and retention of GPs and practice staff has remained difficult, but positive progress has been made. Reliance on locums has been reduced but remains a considerable cost burden.

Jon Sussex, report co-author said: “Keeping GP practices staffed and open is a prerequisite. Achieving that creates the opportunity for better and more integrated care. The GP practices have been able to offer patients the opportunity to consult a range of health care professionals including staff with special training to provide specific types of care for people with diabetes or problems with joint pain, for example.”

The report 'Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation' is authored by Dr Manbinder Sidhu of the Health Services Management Centre at the University of Birmingham, Jon Sussex from RAND Europe and Jack Pollard, formerly from RAND Europe but now at the Health Economics Research Centre at the University of Oxford.

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  • The Health Services Management Centre (HSMC) at the University of Birmingham is one of the UK's foremost centres for research, evaluation, teaching and professional development for health and social care organisations. HSMC has established a unique reputation as a 'critical friend' of the healthcare community and strives constantly to bridge the gap between research and practice.
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