Scotland/ England; Similarities Founding principles Universal, comprehensive, free Strong primary care tradition GP as “gatekeeper” UK contracts Policy priority for long term conditions Performance, access and patient satisfaction

Scotland/ England; Differences  E – purchaser provider split S – unified Boards  E – PCTs, Hospital Trusts, Foundation Trusts, MH Trusts etc S – Unified Boards (CHPs too)  E – Practice based commissioning S – Unified Boards

More differences  E – open to competition and the market S – closed to competition and the market  E – many funding streams S – few funding streams  E – more autonomous (fragmented) S – more integrated (centralised)

Traditional viewEvolving model of care Geared towards acute conditions Hospital centred Doctor dependent Episodic care Disjointed care Reactive care Patient as passive recipient Self care infrequent Carers undervalued Low tech Geared towards long-term conditions Embedded in communities Team based Continuous care Integrated care Preventive care Patient as partner Self care encouraged Carers supported as partners High tech Shifting the balance

Different improvement models From LeGrand 2007

Integration; the key to the interface? Shared outcomes Systems/ Infrastructure Clinical/ Provider Financial Service delivery and patient experience Culture and ethos