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Evaluation of the Inner North West London Integrated Care Pilot

Researchers from Imperial College London and the Nuffield Trust have published the findings from an evaluation of the first year of a project designed to deliver more integrated care to patients in North West London. The Inner North West London Integrated Care Pilot is a large-scale programme focused on developing new models of care planning and coordination for people with diabetes and those who are over 75 years of age. The pilot is being implemented at a time of major reform of the NHS in England, and has been the subject of significant attention among policy makers and commissioners wanting to encourage new models of integrated care.

The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes. The pilot was evaluated by Imperial College London and the Nuffield Trust between September 2011 and July 2012, with funding from the Imperial College Healthcare Charity and the NIHR CLAHRC for NW London. They found that the foundations for change had been laid, with the pilot making good progress in designing and implementing a complex intervention. Progress was underpinned by a new set of governance arrangements and financial incentives.

However their report also notes that analysis of the first tranche of patients treated under the new case management arrangements did not show any significant reduction in emergency admissions or significant changes in the wider use of services. The researchers warn that it would take longer to see any such impact. Imperial College London’s e-Health Unit Director Dr Josip Car stated: “The evaluation reveals the achievements and challenges that would be familiar to those who have attempted to bring about large-scale transformational change in the NHS in the past. There were some changes in the process of care recorded on GP information systems. For example, there was a marked increase in diagnoses of dementia after August 2011, when the pilot started and in the frequency of testing for diabetes.

Since the evaluation a second larger pilot building on the model developed in Inner North West London has since been established in Outer North West London. Together both are looking at moving to a more ambitious ‘whole systems’ approach, based on risk stratification rather than disease pathways.

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