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The key lessons from Canterbury are One fund, One system and Collective leadership. We have been trying to do the latter two in our patch, with limited success. The first, 'one fund' seems crucial in getting rid of commissioning barriers and bureaucracy. It is a barrier to integration, and incentivises gameplay. And yes- it has to be clinically driven, not necessarily 'medically' driven. I agree with 'consultant physician' response on 20th Feb at 11.07. Primary and secondary care have to work together in designing and implementing clinical pathways.