There was a fascinating session at the PCN Plus Conference in which colleagues from West Essex presented how they are working together.  This included leaders from the acute trust, community services, social care, general practice and the ICB.  What they presented really challenged my thinking about who should become an integrated health organisation (IHO).

Plenty of people working in or with general practice, including myself, bring a healthy scepticism to the notion that an acute trust could or should be identified as an IHO.  Just the idea of the acute trust holding the funding for general practice is enough to bring most people in the sector out in cold sweats.

This is not without good reason.  There is little or no track record of acute trusts investing into general practice and community services.  Those of us with long enough memories remember that community trusts had to be separated from acute trusts only 20 years ago because of the stripping of community resources to fund acute services.

But there is an argument that it would make sense.  If you take any local health community with an acute trust at its centre at least half of the total funding is going to the hospital.  They have the deepest pockets, and are the ones most able to make any shift occur.

The problem is we don’t trust them to do this.  We know the financial pressures acute trusts are under, and expect any widening of their income to be used to ease this pressure – to the detriment of all other providers.

So it was hugely refreshing to hear Thom Lafferty, the CEO of Princess Alexandra Hospital, talk about the need for a shift of resources to primary and community care.  He was clear that the solution to the pressures his hospital is under will only come from a change in the way the whole health community operates, and that this requires a shift of resources out of his acute.

The GP leaders had clearly bought into this.  The GP leaders came across as extremely astute and well informed, and so this isn’t a case of the wool being pulled over their eyes.  Trust has clearly been built, and there were concrete examples of how the Trust is actively trying to support general practice, such as providing estates.

What was even more interesting was the CEO sharing how he was coming under pressure from NHS England because of the challenges they are experiencing with acute operational targets.  When he explained to them that his plan to address these was founded on working across the whole health community (in line with NHS England’s own strategy!) it didn’t sound like this was what NHS England wanted to hear.

This raises a really interesting question.  Which are the best organisations to become IHOs?  Do we want it to be the trusts that have their finances, waiting lists and waiting times under control?  Because won’t they want to protect what they have, and be the ones most likely to continue the historic shift of resources from community to acute care?

Wouldn’t it be better for it to be those acute trusts with performance challenges who genuinely believe the only way out of their current predicament is a change in the way the whole system operates (like Princess Alexandra)?  Surely the key point is not one of operational grip, but rather of a genuine, bought-into strategy to change the way things work by investing in out of hospital care.

From being extremely sceptical about the IHO model, I do now think there is possibility that it could work, and for the benefit of both the whole system and general practice.  At present the potential risks still seem to me to outweigh the potential benefits, but the key will be whether NHS England will let those places like West Essex where the whole system wants to do things differently become IHOs, or whether it insists on focussing on those organisations without financial or operational challenges which feels like a recipe for disaster.  I for one will be watching with interest to see how the story in West Essex unfolds.