Integrated care: a story of hard won success

The same patient was admitted to an emergency department 19 times in six months with hypoglycaemia, but no one ever told his diabetes consultant in the same hospital. The North West London integrated care pilot is working to ensure that never happens again.

The pilot was launched in 2011 to meet the needs of people with diabetes and those aged over 75. It brings together primary care, community services, acute care, social care, and mental health.

It was set up because local hospital trusts needed to reduce pressure on beds and respond to the funding cap that the tariff system now imposes on emergency admissions, while commissioners wanted to raise quality while cutting costs as part of their response to NHS budget constraints.

So far 93 general practices serving more than 500 000 patients have signed contracts with the pilot, along with four hospitals, three community providers, and five council social care departments. The partners are organised into 10 multidisciplinary groups spread across northwest London.

The aims are to cut hospital use, including non-elective medical admissions, by 30% over five years and nursing home admissions by a tenth, while reducing the £620m (€770m; $980m) annual cost of services for diabetic and older patients by 24% over five years. The savings in non-elective admissions alone—cutting these by 30% equates to roughly one fewer admission per GP per month—are expected to release £10-12m a year for reinvestment. Early results are promising. Between July 2011 and January 2012 the number of non-elective medical admissions among the 28 000 patients aged 75 and over fell 6.6% compared with the …