Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

This article addresses the challenge of how to implement integration within primary care services. It shares learning from a UK based improvement programme which reflected international interest in transferring activities from hospital and community and developing holistic primary care that responds to the needs of the local community. Programme components included additional per capita funding for involved practices, monthly learning sets between pilot leads, and a formative evaluation. Practices had flexibility in how to use the additional funding to meet local needs and were selected through a competitive process. The programme successfully delivered diagnostic and treatment activities previously provided in acute hospital. Some practices also introduces new holistic approaches which were mostly sustained at the end of the twelve month period. The programme demonstrates that transformation of primary care requires a change in the internal paradigms held by clinicians and purchasers, careful design of learning opportunities, responding to multiple levels of motivation, and deployment of relevant change infrastructures and improvement methodologies.