Greater collaboration is needed between primary and secondary care commissioners to avoid "adversarial competition" arising from practice-based commissioning (PBC), according to the NHS Alliance.

Dr Minoo Irani, a consultant paediatrician who leads the NHS Alliance Specialists in Primary Care Network, says government policies to shift care out of hospital demand closer collaboration and new ways of working between primary and secondary healthcare services.

Dr Irani said: "Adversarial competition, resulting from PBC and payment by results, has led to PCTs, NHS trusts and foundation trusts competing for organisational preservation, while clinicians have been polarised into professional self-preservation mode."

In a new discussion paper, Integrated healthcare services – the future of commissioning and provision of out of hospital healthcare in the NHS, Dr Irani proposes solutions for a seamless healthcare system.

These proposals include the introduction of "integrated provider organisations" based around one or more PBC groups (depending on population size), and the creation of community specialists and consultants whose expertise and status would be equivalent to their hospital-based counterparts.

"The needs of the patient for a seamless healthcare system risk being compromised unless something is done to address this 'wrong sort of competition'", said Dr Irani. "The model we propose addresses these issues."

The NHS Alliance also argues that the development of integrated healthcare must now be taken forward by clinicians, rather than waiting for the imposition of structural change from above.

To begin that process, they have invited the Royal College of Physicians, the Royal College of General Practitioners and the British Medical Association to work in partnership with the Alliance.

NHS Alliance chairman Dr Michael Dixon said: "We have long argued for greater collaboration at the clinical interface between primary and secondary care. The solution we've put forward is practical, achievable and cost effective.

"Now we hope our secondary care colleagues will join with us in developing it further."

NHS Alliance

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"I am pleased to report that the Royal College of Physicians (RCP) has been working on this very issue, and invited members of the Alliance, the RCGP and more recently the RCPCH to join in a group which has been exploring partnership working for the last eight months. We meet regularly at the RCP in London, and look forward to our continued work on this project" – Mike Cheshire, Clinical Vice President, Royal College of Physicians