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The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study

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Title: The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study
Authors: Naqvi, D
Malik, A
Al-Zubaidy, M
Naqvi, F
Tahir, A
Tarfiee, A
Vara, S
Meyer, E
Item Type: Journal Article
Abstract: Objective: There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (General Practitioners and Practice Managers) towards these barriers to integration. Design: Qualitative study using semi-structured interviews and thematic analysis to obtain results. Setting: General Practices within London. Participants: 18 General Practitioners (GPs) and 7 Practice Managers (PMs) based in London with experience of working with social care. Results: The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships, and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between Information Systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors. Conclusion: In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.
Issue Date: 20-Aug-2019
Date of Acceptance: 2-Aug-2019
URI: http://hdl.handle.net/10044/1/72749
DOI: https://dx.doi.org/10.1136/bmjopen-2019-029702
ISSN: 2044-6055
Publisher: BMJ Journals
Journal / Book Title: BMJ Open
Volume: 9
Copyright Statement: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: barriers
general practice
integration
primary Care
social Care
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status: Published
Article Number: ARTN e029702
Online Publication Date: 2019-08-20
Appears in Collections:Imperial College Business School