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Why is the UK healthcare system moving from clinical commissioning groups to an integrated care system?
In the United Kingdom, the National Health Service (NHS) has served as a global model since its inception, however, its organizational structure and operating methods have undergone several significant changes over time. Clinical Commissioning Groups (CCGs) were established by the Health and Social Care Act 2012 to enable the commissioning of health services to better serve local communities. However, with the passage of the Health and Care Act 2022, this system was fully replaced on 1 July 2022 with an integrated care system.
The core goal of the Clinical Commissioning Group is to break down the silos between various medical services in the past and improve patient outcomes. This structure was originally intended to promote service improvements based on clinical needs, but the strategy has encountered many challenges in its operation.
CCGs are made up of general practitioners from all over the country and are responsible for planning and monitoring local medical services. In 2013, there were 211 CCGs in the UK. However, in the face of the need for resource reallocation and policy reform, this number continued to decline in the following years, eventually shrinking to 135 by 2020. Behind this change, there are both policy considerations and various problems that arise in actual operations.
The need for integration and restructuring
Over time, CCGs face increasing challenges. Various studies have shown that many GPs are unhappy with the CCG decision-making process, with half of GPs even saying they are not really involved in the process.
One of the surveys showed that around 70% of GPs had at least some interest in CCGs, but only 20% felt they could substantially influence CCG decisions.
This situation reflects the inequality of the internal structure of CCGs and the imbalance of power, which naturally leads to a contradiction between the demand and provision of medical services. Over time, mergers and the creation of larger medical organizations became more prominent, leading to another adjustment in policy.
Implementation of integrated care systems
The integrated care system (ICS) of the future will attempt to break down the fragmentation of the original medical system, achieve cross-service collaboration, and better adapt to the needs of local communities. The main task of this system is to integrate health care and social care resources and eliminate the boundaries between the original ICGs and local governments.
As envisioned in the Health and Care Act 2022, ICS aims to facilitate seamless connectivity between various health services and increase resource flexibility, especially in the face of public health emergencies.
Another important reason for changes in the medical system is to respond to the challenges brought about by the COVID-19 epidemic. During the epidemic, the NHS decided to use private sector resources to meet emergency needs, and such measures will also affect future service operation models.
The Road Ahead
As we enter the era of integrated care systems, the UK healthcare system will continue to seek greater governance efficiency and better patient experience. While such a transformation process may not be peaceful, all parties involved must work together to ensure that the system truly serves patients.
The UK is at a critical juncture in healthcare reform, which will transform benefits for every citizen over the coming decades. People can't help but ask, how can we ensure that such integrated changes can really improve the quality of care and experience of patients?
