Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

Abstract

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

Dynamic Surgical Waiting List Methodology: A Networking Approach

“…), who, as a whole, contribute to the recovery of patients in all care processes, including the support of the internet of things in SWL (see, e.g., Oddershede et al [39]). On the other hand, authors such as Sidhu et al [25] and others have developed qualitative and comparative case studies to address the strategy of networks. Others, such as Turgeon et al [40], Peduzzi and Agreli [41], have offered networking methodologies to better service patients, e.g., drugs for cancer treatment.…”

“…From the point of view of disease prevention, it is vitally important to consider integrated care management and network collaboration to avoid complex health situations or investigate them in their early stages, to reduce the admission rate of SWL, or prevent patients from worsening their clinical condition when they enter the list. For this reason, authors such as Hungin and Rubin [21], Wadmann et al [22], Abad [23], Cicchini et al [24], Sidhu et al [25] and others have considered that the development of government initiatives for health work is an essential network collaboration for both institutions and professionals, which would allow greater satisfaction of patients and better management of healthcare resources.…”

Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation

“…A diagram of Seaview's vertical integration organisational structure is provided in Figure 3. The rationale for vertical integration for Urbanville was to better manage demand in the local health economy through (1) improving patient access to primary care services, (2) increasing quality of care and (3) increasing opportunities for innovation. l GP contracts have been directly taken on by the acute hospital trust.…”

“…A theory of change illustration for this case study site is presented in Figure 4. The central rationale for integration between the acute trust and primary care practices was to better manage demand in the local health economy through (1) improving patient access to primary care services, (2) increasing quality of care and (3) increasing opportunities for innovation. Collectively, this would, it was hoped, lower the whole-system cost of treating patients.…”

“…We have investigated (1) what specifically has led to hospitals and general practices being run by the same organisation (i.e. vertical integration); (2) how vertical integration is carried out; (3) the expectations of the general practitioners and NHS managers who make vertical integration happen; (4) whether or not those expectations are being fulfilled; and (5) whether or not there are any other consequences of vertical integration.…”