Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention.

Towards a strategic alignment of public health and primary care practices at local levels - the case of severe and enduring mental illness.

The rapidly increasing number of people who have long-term conditions requires a system of coordinated support for self-care throughout the NHS. A system to support self-care needs to be aligned to systems that support shared-care and community development, making it easier for the multidisciplinary teams who provide care to also help patients and populations to help themselves. Public health practitioners need to work closely with clinicians to achieve this. The best place to coordinate this partnership is a community-based coordinating hub, or local health community - a geographic area of about 50,000 population where different contributions to self-care can be aligned. A shared vision for both health and disease management is needed to ensure consistent messaging by all. A three tier system of shared care can help to combine vertical and horizontal integration. This paper uses severe and enduring mental illness as an exemplar to anticipate the design of such a system.

Community-oriented integrated mental health services.

Unprecedented levels of cost containment in NHS and social care organisations - together with integration as a policy priority - make this a key moment for fresh ways of thinking about how to commission and provide community-based integrated services that meet the challenge of local accountability and citizen participation. This is nowhere more important than in mental health. Primary care with its local orientation is properly at the heart of this agenda, but there is a need for new forms of leadership for collaboration in the sector. In this context, the contribution of general practitioner (GP) networks is likely to be fundamental. This paper is a brief discussion of some of the issues associated with GP networks and mental health, set in the context of a round table discussion with three sets of participants at a 2014 London Journal of Primary Care/Royal College of General Practitioners conference. The conference provided a forum for capturing a diversity of experience and knowledge and for turning this into a force for critical transformation. This paper describes a contribution to the day.