Care pathways: have they a place in 'the new National Health Service'?

AIM: To discuss the use of Integrated Care Pathways (ICPs) as tools for ensuring cost-effectiveness and high quality patient-focused care. To examine how electronic pathways combining process, practice and audit might be effectively used by Primary Care Groups as a tool to integrate care within the 'New National Health Service'. KEY ISSUES: It has been argued that for doctors pathways lead to 'cook book medicine' and for nurses they move practice away from patient-centred care back to a disease/task-based model. This article explores the origins of pathways, addresses the concerns of critics and goes on to describe a pathway strategy.
CONCLUSIONS: Pathway development offers the potential to create a coherent plan of care and treatment (across primary/secondary care) which incorporates evidence-based practice and reduces fragmentation and duplication whilst aiding co-ordination and communication. The incorporation of clinical indicators and measurable goals ensures the audit process is embedded.