In straitened times "shared services" are the philosopher's stone of the public sector, holding out the golden promise of improved services and efficiency, transmutated from the lead weight of budget cuts.
Undertaking the "great work" in healthcare is Aldershot Centre for Health (ACH), a £28m "one-stop shop" that opened in the Hampshire town in 2008.
The UK's largest, it serves a local population of 45,000 and a wider catchment area of 250,000. Under one (huge) roof it houses NHS Hampshire, Hampshire Community Health Care, Surrey PCT, Surrey and Borders Partnership Trust, Frimley Park Hospital, three GP practices and the Ministry of Defence (British Army).
Science has played a leading role in this particular alchemical enterprise – electronics, specifically. ACH's single integrated IT network, developed by Logicalis, knits clinicians and healthcare workers together and allows for cross-agency collaborations.
Staff can use the same log-in details for all systems and applications, as well as access their own desktop sessions from any workstation in the building. Integration has had to be segmented enough to guarantee each agency's "native" network is secure, protecting patient confidentiality and MoD data.
"The original intention had been for each occupying organisation to do its own thing in IT terms, but this would have resulted in a fragmented offering with unnecessary duplication, which is far from conducive to facilitating joined-up healthcare," explains Karl Goatley, IT programme director at NHS Hampshire.
Having multiple services under one roof allows, for example, patients to see their GP, attend an outpatient appointment, have blood tests and x-rays taken, attend physiotherapy and pick up prescriptions from an onsite pharmacy. ACH is also the UK's first multidisciplinary centre for health and social care.
Dr Murdo Macleod, a GP at the ACH's Victoria Practice, suggests that a process of acclimatisation is still ongoing.
"GPs have been taught to think of general practice as a small business, which was useful in terms of trying to innovate and improve relative to other practices, but with the downside that, simply by dint of size, there would always be someone with more skills, expertise or resources," he says. "The ability to work in combination, while still having that slightly competitive edge, will only benefit patients."
For him, a major plus is that health staff such as midwives, working across ACH's three general practices, can access patients' notes direct rather than having to talk to doctors, and are also able to input details of their visits direct.
In March, the government's Total Place report identified "shared management and joint working arrangements" as a main area for potential savings in the public sector, citing OEP figures showing that sharing back office services (internally or across other organisations) could deliver savings of up to 20%.
LSE health economist Zack Cooper says most health centres will soon be travelling in the same direction as ACH, bridging the gap between primary and secondary care and dovetailing nicely with the coalition government's drive to move care out of hospitals.
"In general, integrated centres are a pretty good idea: reducing delays in treatment, increasing coordination, improving patient outcomes and encouraging providers to think differently – a failure to innovate has long been a hallmark of the NHS. The downside is that they can sometimes underprovide, with the incentive to do everything in-house, whether it's the right thing or not," he says.
Macleod says the main concern for patients is to be treated well and quickly. "There is a degree of pressure centrally to try to do more within the primary sector rather than referring patients on," Murdo says. "Inevitably there is a danger that some who may be better off in hospital will not receive treatment there, but on balance people prefer to be treated within primary care. Bigger integrated practices such as this one are better placed to do that work."