Coordinated care: a patient perspective on the impact of a fragmented system of care on experiences and outcomes, drawing on practical examples.

The NHS has been on a journey of major structural change since its first significant reorganisation in 1974. In recent times, the emphasis has been on developing the market philosophy first introduced by Margaret Thatcher in 1989. As service commissioning develops, and more providers join the market, many patients find the system difficult to navigate and complain of fragmentation in the delivery of care and of new services failing to provide the high quality of care they expect. This article examines the impact on patients of a fragmented system of care, drawing on some practical examples. If person-centred care is to become a reality across the NHS then collaborative approaches to commissioning and delivering care must be developed.