This project completed on
26 Sep 2012

Handing control of commissioning budgets over to groups of primary care clinicians was one of the most radical reforms set out in the Health and Social Care Act 2012. Aiming to support policy-makers and practitioners in the English NHS, this project examined the lessons from the experience of organised general practice in New Zealand.


John Macaskill-Smith, Chief Executive of the Midlands Health Network, discusses the development of integrated care in New Zealand.

Networks or groups of primary care physicians are the focus of much policy interest worldwide as a potential vehicle for more integrated, community-based care, especially for people with long-term conditions.

All health systems face cost pressures and are looking for ways to develop integrated care that is less dependent on high-cost hospital inpatient services. Physician groups have already developed in a number of countries, including the Unites States, Australia, New Zealand and Canada.

In England, the Government hopes that clinical commissioning groups will be the driver for more efficient integrated care. A crucial component of this is likely to be the quality of primary care itself, however, there has been only limited attention paid by policy-makers to the problem of how best to achieve this.

As private organisations, IPAs were autonomous and innovative, but at the same time it meant that accountability for public money was sometimes weak

This project analysed the development of primary care-based physician groups in New Zealand, where there is a long standing network of independent practitioner associations (IPAs). Many of these IPAs have been effective vehicles for improving the quality of primary care and are now playing an important role in the design and development of more integrated health services.

In our report: Primary care for the 21st century: learning from New Zealand’s independent practitioner associations (Nuffield Trust, September 2012), we document the history and experience of IPAs in New Zealand. We assess their achievements, examine the factors that enabled and inhibited the progress and achievements of the IPAs, and consider the next steps for New Zealand in the context of international interest in the development of integrated care.

Our research found that IPAs were an effective way to bring together isolated primary care physicians and that some IPAs proved very adept at innovating in service provision, as well as adapting to numerous changes in national policy.

IPAs’ success in generating savings also highlighted a dilemma facing government policy-makers: as private organisations, IPAs were autonomous and innovative, but at the same time it meant that accountability for public money was sometimes weak.

This publication has strong relevance to policy-makers and practitioners in the UK as they set about examining the potential of groups of clinicians acting as both commissioners and providers, and as a means to change the relationship between primary and secondary care for the benefit of patients.

Project outputs

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