Delivering integrated care requires single multidisciplinary teams with all the relevant skills as described in Chapter 6: How do we innovate a new model of care working with users and carers? and that can be held to account for the outcomes described in Chapter 5: What are the outcomes to be delivered? This requires more than an effort in coordination of front line professionals.
For these teams to be successful, they require a clear line management structure, which needs to be supported by a formal network structure of provider organisations so that teams can be performance managed and resources allocated to where they are needed most. The working group considered six governance structures for provider networks that could be used to support integration and improved care models.
The available structures vary chiefly in the degree of integration they support and the difficulty of setting them up. In addition, some face regulatory constraints that limit their applicability.
Structures that facilitate lower levels of integration typically
- Are easier to implement
- Maintain existing care models and processes where they have been successful
- Preserve existing skill sets in the environments they have been built for
- Increase the ability of the system to support competition between providers
However, structures that increase levels of integration typically
- Improve the ability for single decision-makers to reallocate funds to deliver the best possible care irrespective of the setting it is provided in
- Create a single point of accountability to commissioners
- Increase the ability for shared services to improve the effectiveness of the whole system
- Reduces the degree to which provider self-interest motivates decision-making
Working Group Opinion
A working group of providers, commissioners and lay partners discussed the proposed options for provider network structure. They were strongly in favour of moving towards a more integrated organisation, in the form of a corporate joint venture with other providers. In fact, many of the service user representatives were surprised to learn that care is not already provided in this way.