By Neil Roberts, 22 January 2014

NHS England officials plan to overhaul funding arrangements for the whole urgent care system, but admitted to fears that councils could misuse health service funding intended to promote integration.

Part of NHS England’s ongoing urgent care review will look at ways to allow integrated funding of urgent care pathways across primary and secondary care, its acute care director Professor Keith Willett told MPs on the House of Commons health select committee.

The current fragmented system of different funding and commissioning systems for general practice, hospitals, ambulances and community care services meant even when the sectors were brought together to commission integrated urgent care pathways caused problems, said Professor Willett.

Professor Willett, who is leading the review of urgent care under NHS England medical director Sir Bruce Keogh, said: ‘When we come to allocate the money, again, we are still stuck with those methods.

‘So one of the large pieces of workstream we are doing within the review will be to look at that whole funding structure,’ he said, to find new funding mechanisms to support more ‘activity out in the community’.

Professor Willett said the government’s £3.8bn Better Care Fund for integrating health and social care would be used to move care out of hospitals into the community and social care sectors.

But Sir Bruce admitted to MPs that there was ‘great scepticism’ that the fund would reduce demand on emergency departments, and fears within the NHS that local authorities will misspend the pooled budgets on other council services such as ‘filling in potholes’.

Sir Bruce also revealed that private companies could be called in to provide planned NHS operations to ease pressure in the event of a winter surge at hospitals.

In November, the first report of the Keogh review of urgent care services called for a dramatic rise in the proportion of urgent care delivered closer to home.

The report recommended the bureaucratic burden on GP practices must be cut to boost access to primary care and reduce pressure on A&E.

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