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A future vision for the NHS: structure of healthcare systems

How could leaders in the NHS create an environment where doctors are incentivised to work across the interface between primary and secondary care?

To provide the best care to patients, doctors and other NHS staff need to be able to work together. Yet the reality facing doctors is that bureaucratic barriers and artificial boundaries getting in the way of delivering high quality patient care.

Across all four nations, more needs to be done to enable doctors working in primary, community and secondary settings to work collaboratively, putting patient care above organisational or financial interests, and reducing duplication and bureaucracy. There is a history of initiatives to promote integrated working across the UK at local and national level. While it is a notoriously challenging issue, there is no doubt that greater joint working will be required to care for the increasing number of patients living with multiple long-term conditions, and there is recognition in all nations that integration needs to be improved.

In England, there is the added dimension of a market model in health, with competition for services, and payment and commissioning systems which create perverse incentives and wasteful competition which are not conducive to collaboration or good patient care.

We will explore with members how health systems should be structured in a way which best supports healthcare professionals to collaborate, innovate and deliver high quality care. It will also involve considering the concepts such as population or place-based care, and how we can create an environment in which people across the NHS are empowered to work together more effectively whilst maintaining professional autonomy. And, crucially, it will be centred on patients, asking what clinical pathways would look like in a more collaborative system.


Get involved

As part of the Caring, supportive, collaborative project we’ve now started a conversation with doctors across the country through a series of local engagement events. These events give doctors an opportunity to contribute their views to our collective vision for the future of the NHS. 

The events focus on the themes of the project:

  • Culture - How do we create a supportive working culture in which doctors and staff feel able to provide safe, quality care for patients? 
  • Workforce - How would you reduce the system pressures on doctors and increase retention?  
  • Collaboration and structure - How could leaders in the NHS create an environment where doctors are incentivised to work across the interface between primary and secondary care? 

If you have a view on any of these questions, please share it with us at [email protected].

We want to develop positive and workable solutions, and this takes bold thinking. Your contributions will be vital in driving this project forward, to help us create a future vision of the NHS that is caring, supportive and collaborative.

Further information on the project is available here

Find details of upcoming Caring, supportive, collaborative events here