title: Integrated care cannot be designed in Whitehall.
abstract: In recent years England has introduced a number of initiatives to promote more integrated care. Two contrasting examples are the GP-led health centres and the Integrated Care Pilots announced in the interim and final reports, respectively, of the NHS Next Stage Review in 2007-2008. The GP-led health centres were proposed as a very centralised, prescriptive approach where the aim was that all the NHS should adopt the same model of facilitating integration through co-location. Integrated Care Pilots, on the other hand, looked to the NHS to suggest their own solutions to improve integration, resulting in a variety of solutions tailored to the needs of localities. Although the results of the evaluation of the Integrated Care Pilots have been equivocal, this bottom-up approach must be the right way to foster integrated care. Long-term commitment to integrate care is needed, as well as more exploration of integration between primary care and hospitals.
authors.affiliation: Paul Hamlyn Chair of Surgery, Imperial College, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Peter
authors.initials: P
authors.lastname: Howitt