1. NHS Next Stage Review and Primary and
Community Care Strategy
“We will test and evaluate new ways in which PCTs can
commission more integrated services from innovative
groups of clinicians.
We will invite proposals for pilots that involve clinicians
NHS Next Stage Review
working on a more collaborative basis across primary,
community and secondary care – and with local
authorities and other sectors – to achieve more personal,
responsive care and better health outcomes for a local
population (based on the registered patient lists for
groups of GP practices).”

2. What do we hope to achieve through the pilots?
Build a more robust evidence base to prove that integrated
care can improve health outcomes at a faster rate than
existing models of provision
Clinical leadership to achieve a measurable leap in health
outcomes
Learn how a PCT can commission for integrated care
Understand how the existing reform levers need to be
NHS Next Stage Review
adapted, if at all, to incentivise integration (choice, PBR,
competition etc)
Better understand the conditions within integrated care that
accelerate improvement (size, 1° or 2° pull etc)
Making the business case !

3. Potential national outcomes for integrated care
Improved quality of care, health, equity and economy in a
specified target population, and at a faster rate than in
comparable populations.
Improved patient satisfaction, patient reported outcomes,
quality of life and partnership in their care
Improved and better value care – and more effective and
economic systems
NHS Next Stage Review
Improved professional, organisational and system
effectiveness
Compelling evidence of what works
For each of the above we need to identify appropriate
indicators/metrics/process markers

4. Massachusetts General Primary Care/Medicare pilot
2k population – risk stratified around co-morbidities
Control patient group
Aims to reduce costs by 5% compared to control group
(50% profit share with medicare)
NHS Next Stage Review
After 18 months (plus 6 month lead in time)
Costs reduced by 18%
Medication compliance improved
Admissions and ER visits reduced
LOS down