Patients are still being confronted by a fragmented and complex picture of services when accessing the NHS.
This is the key finding of a report by the Royal College of Physicians, which outlines many of the structural and systematic challenges faced by patients.
The report, called Putting the pieces together: removing the barriers to excellent patient care, also presents a vision of how to reform and improve the systems and structures that underpin the NHS.
In some areas of patient care, physicians have found that services are planned and commissioned in such a fragmented way that care is often disrupted and in some cases not available at all.
It becomes too complicated for patients to negotiate diverse services, often in located in different places, with different healthcare providers and professionals, the report finds.
RCP Registrar Dr Andrew Goddard said: “Time and time again we see services that are often planned and commissioned in a fragmented way, looking at one small part of a patient’s treatment – without due consideration of other, closely related areas of care.
“We need a system that enables doctors, nurses and others on the front line of the NHS to deliver the safest, most effective care, in whatever setting which is most appropriate for each patient’s needs.”
However, the report also describes examples of commissioners, service planners and clinicians building strong, collaborative relationships to improve patient care.
For example, in London and the West Midlands commissioners have drawn on the frontline expertise of local dermatology consultants in solving commissioning challenges.
In Cheshire, acute physicians have reached out to build strong relationships with commissioners in order to enhance patient care.
To support such models, the report has priority areas for action and a set of core principles outlining how clinicians, commissioners and service planners and clinicians can support excellent patient care.
– Empowering commissioners to collaborate
– Valuing quality of care above competition
– Valuing clinical engagement and joined up leadership
– Not making short-term plans for long term problems
– Building better payment systems
– Fostering a sustainable workforce
– Promoting innovation
The report calls on those across the health system – government, regulators, commissioners, providers and royal colleges – to work together to ensure the patient is put first.
The chair of the RCP’s Patient and Carer Network, Elisabeth Davies, said: “We need an NHS that puts the patient first and delivers on its promise of patient centred care. We won’t get it until services are being planned for the long term around the people who use them, not around short term systems and processes.
“Quality of care is about patient experience as well as clinical effectiveness – fragmented services won’t deliver this.”
Accompanying the report is a practical guide for physicians, working in hospitals and communities across England, to help them play their part in improving the way that NHS services can be planned, commissioned and funded.
It aims to help physicians to get involved in shaping the way patient care is designed and delivered locally, regionally and nationally.