Abstract
This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub – both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into ‘wicked problems’, and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention.
Highlights
Why this matters to us London Journal of Primary Care (LJPC) is a network of people who want to develop community-oriented integrated care
In 2017 LJPC started to develop a network of collaborating sites to better understand how to achieve community-oriented integrated care and health promotion in different contexts [3]
Throughout the world, ways to evaluate community-oriented integrated care are being considered both as a theoretical approach to systems research [33] and as practical evaluation of contemporary models such as the UK New Care Models [34] and Primary Care Homes [17]
Summary
Throughout the world, in one way or another, since 1978 the concept of COIC has been advanced. In the UK, with the Five Year Forward View, COIC has come of age It is an intrinsic part of the Accountable Care concept, more recently termed Integrated Care Systems, currently being implemented throughout the UK. The current commissioning paradigm is likely to be replaced with one based on capitation budgets that will be shared between provider organisations in Primary Care, Acute and Community Trusts, and Social Care This new paradigm focuses on whole population outcomes. Secondary Care will probably hold the lion’s share of capitated budgets within Integrated Care Systems These new contracts will be judged by population health outcomes, and will have longer time-spans with less emphasis on in-year balancing of budget. In addition to the short term, focused outcomes of treating disease, evaluation of COIC will need to consider longer-term and broader impacts including the wider determinants of illness AND the wider determinants of health, local communities for health, sustained collaborative efforts, whole system impact, unexpected outcomes, and improved resilience of the individuals and communities involved
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