A Rapid Evaluation of Staff and Patient Experiences of Care Delivery as Part of a Vertically Integrated Model of Care

Purpose

To understand the impact vertical integration between primary and secondary care providers has on the patient journey regarding access to and overall experience of care.

Design/methodology/approach

Cross-comparative case study qualitative evaluation comprising: (1) focus groups and one-to-one interviews with key service managers and clinicians from acute hospitals and GP practices; and (2) one-to-one interviews with patients from integrated GP practices, to understand their experiences of vertical integration models. We used the SELFIE (Sustainable intEgrated care modeLs for multimorbidity: delivery, FInancing and performancE) framework as a lens to guide our qualitative study.

Findings

Vertical integration between acute trusts and general practices is supported by the introduction of novel ways of clinically integrating care across primary, community and secondary healthcare organisations to meet the needs of all patients locally, but specifically those at risk, with complex, and/or multiple long-term conditions. Health service improvements are driven by local acute trusts, in collaboration with clinicians in general practice, and focus on health service changes that can improve population health for all patients locally. Vertically integrated practices are used to test services before encouraging wider local roll-out to non-vertically integrated practices.

Originality/value

For vertical integration to be implemented successfully, there is a need for an initial period of trust and relationship building between staff (clinicians and other staff) in primary care and in secondary care. Patients undertake significant “navigation work” concerned with choosing and accessing health provision; however, this holds true for both vertically integrated and non-vertically integrated general practices nationally.