New conversations between old players? The relationship between general practice and social care in an era of clinical commissioning
Jon Glasby Completed 2012
Jon Glasby Completed 2012
General practitioners are the gatekeepers and care coordinators for the NHS as a whole, and also provide much of the direct clinical care within primary care. Their relationship with adult social care is central to the delivery of integrated care to individual patients/service users and their families. Following the Health and Social Care Act 2012, English GPs have the lead role in commissioning local NHS services. This relationship will also therefore be a key feature of the strategic planning and market shaping of health and social care services for populations. Despite the importance of GPs to achieving integration there is relatively little known about how GPs and social care currently work in practice, with most of the key studies being undertaken at the end of the last century.
This review sought to examine the more recent evidence that is available about joint work between general practice and adult social care in relation to older people. This incorporates both ‘integrated working’ (at a practice or operational team level in relation to individuals and their families) and ‘partnership working’ (at an organisational or strategic level in relation to the needs of populations or sub-groups of populations).
The resources available for the review meant that it was not possible to consider the experiences of all user groups supported by adult social care. Older people were chosen as they comprise the majority of people actively supported by social care and general practice, and because they are so central to current debates regarding how best to respond to changing demographics and rising need. Many of the issues that have arisen in relation to older people will potentially be transferable to other user groups; however, it is recognised that other adult user groups will have differences as well as similarities to that of older peoples’ services.
The review involved review of key knowledge regarding joint working available in 2000 (the date of a previous key review), and then a review of UK-based literature that has been published subsequently. To set these findings in this in the context of the emerging commissioning structures, interviews were held in late 2012 with ten key stakeholders drawn from health and social care bodies and academics with a particular interest in inter-agency working.
In total the literature review identified nine empirical studies. These studies were very mixed in both their focus and methodology, and encompassed small-scale pilots as well as large, externally-commissioned studies.
Mirroring the broader literature regarding joint working, key issues included the practical difficulties of engaging GPs in inter-agency collaborations; a lack of mutual understanding; different priorities and geographical boundaries; and a turbulent policy context.
Factors that may aid more effective joint working included the importance of time and space to build good relationships; trust and awareness of each other’s roles; clear commitment at practice and senior level; shared priorities and outcomes; and appropriate practical and organisational development support.
The studies contain very little information about costs or savings – and there remains insufficient evidence to know what impact joint working might have on future spending.