OP30 #Integrated care at the frontline: a participatory evaluation of locality level multi-professional teams in east london

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Abstract

Background

NHS England’s new models of care (NCM) offer a platform for local partnerships between health and social care providers to reduce fragmentation of services and to support an integrated approach to care provision that is patient-centred and coordinated. The rationale behind these partnerships is to promote multi-professional working and integrated care, e.g. locality level multi-professional teams. These teams provide care coordination and case management for patients whose needs are most appropriately met by different health and social care professionals. The aim of the evaluation is to assess the enablers and barriers of implementing a multi-professional care model in primary care.

Methods

The model of care presented here is being evaluated using a participatory approach to research: the Researcher in Residence (RiR). The researchers are embedded at the locality level and are using a formative, process-orientated approach employing primarily qualitative methods to gather data including participant observation, interviews, focus groups and documentary analysis. The RiR model places the researcher as a key member of the delivery team and enables co-creation of knowledge between researchers and practitioners, with the aim to increase opportunities for evidence to influence programme development. Furthermore, we have developed a maturity matrix tool which will enable the organisations participating in the evaluation to assess the extent of the development of the locality level teams over time.

Results

Preliminary findings have revealed that a series of system enablers to promote integrated working have been introduced including efforts to co-locate health and social care staff. Whereas co-location might contribute to team building as evidenced by effective working between health professionals, it is not a panacea, and organisational development needs are evident in terms of organisational, cultural and professional issues, i.e. different management lines and organisational pressures, professional identity, trust, and accountability, compounded by rapid staff turnover and high numbers of locum staff.

Conclusion

Frontline staff from both health and social care have demonstrated a desire to ensure delivery of joined up patient-centred care; interdisciplinary teams can potentially play a crucial role in driving greater care coordination. However, a plethora of policy initiatives resulting in continual reconfiguration of community health services while overlooking the same stumbling blocks that have continued to hamper previous efforts at strengthening integrated care may weaken outcomes once again. Better understanding of patterns of collaborations and integrated care pathways is crucial to identify frontline staff’s organisational development needs and provide adequate support.

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