Joint working between general practice and social care challenged by practical barriers and mutual lack of understanding
General practice and adult social care will have to overcome a number of challenges to forge the type of strategic relationships that are needed now that GPs have taken over the lead role in commissioning local NHS services through Clinical Commissioning Groups. A review of the evidence on joint working has highlighted some key issues to be addressed, including the practical difficulties of engaging GPs in inter-agency collaborations; a lack of mutual understanding; different priorities and geographical boundaries; and turbulent policy contexts in both sectors.
The relationship between general practice and adult social care has always been central to the delivery of integrated care to individual patients/service users and their families. Following the Health and Social Care Act 2012 and the formation of GP-led local Clinical Commissioning Groups (CCGs), this relationship will also be a key feature of the strategic planning and market shaping of health and social care services for populations. Yet relatively little is known about how GPs and social care currently work together in practice.
This new review looks at evidence on both ‘integrated working', at practice or operational team levels in relation to individuals and their families, and ‘partnership working', at organisational or strategic levels in relation to the needs of populations or sub-groups of populations. In the context of integrated working, the research suggests GPs and social workers often do not understand the other profession’s unique role, responsibilities and perspectives. Addressing this requires both formal (e.g. shared forums) and informal (e.g. networking) opportunities for the key players to engage with each other.
Moreover, different eligibility and catchment criteria applied to health and social care mean there will be service users who do not fit neatly into both services. This can be frustrating for all parties and a willingness to address such situations positively through, for instance, being willing to work across local authority boundaries, can lead to reciprocal flexibility in the future. The research shows co-location can contribute to better joint working, but this is not guaranteed and needs to be accompanied by organisational development across both agencies.
As Prof. Jon Glasby, Director of the Health Services Management Centre, concludes:
“Overall, the review found that relationships between general practice and social care are often starting from a relatively low base. Despite increased joint working in the late 1990s with the inclusion of social services representatives on the Boards of Primary Care Groups, subsequent reforms led to a focus on the relationship between PCTs and local government, with less engagement from GPs. Collaboration between general practice and social care is crucial, but we still have a long way to go.”
Interviews by the review team with stakeholders drawn from primary health, social care and academia identified that the recent NHS reforms have created opportunities for new relationships, but that progress may be difficult in a very complex policy environment. The views confirmed that general practice and social care practitioners have traditionally had very little strategic contact, with previous relationships focusing on local authorities and Primary Care Trusts. Initial training also does little to prepare either agency/profession for collaboration.
Overall, factors that were identified as having the potential to encourage 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 levels; shared priorities and outcomes; and appropriate practical and organisational development support. The existing literature contained very little information about costs or savings – and the review concluded there was insufficient evidence to know what impact joint working might have on future spending.
The review was funded by the NIHR School for Social Care Research and led by Jon Glasby, Professor of Health and Social Care and Director of the Health Services Management Centre (HSMC), University of Birmingham.
Glasby J, Miller R, Posaner R (2013) SSCR Scoping Review: New Conversations Between Old Players? The Relationship between General Practice and Social Care in an Era of Clinical Commissioning, NIHR School for Social Care Research, London.