Social services representation in Primary Care Groups and Trusts

Collaboration between general practitioners and social workers: a scoping review

OBJECTIVES

Aim of the study is to present an overview of collaboration structures and processes between general practitioners and social workers, the target groups addressed as well the quality of available scientific literature.

DESIGN

A scoping review following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

INCLUDED SOURCES AND ARTICLES

According to a pre-published protocol, three databases (PubMed, Web of Science, DZI SoLit) were searched using the participant-concept-context framework. The searches were performed on 21 January 2021 and on 10 August 2021. Literature written in English and German since the year 2000 was included. Two independent researchers screened all abstracts for collaboration between general practitioners and social workers. Articles selected were analysed regarding structures, processes, outcomes, effectiveness and patient target groups.

RESULTS

A total of 72 articles from 17 countries were identified. Collaborative structures and their routine differ markedly between healthcare systems: 36 publications present collaboration structures and 33 articles allow an insight into the processual routines. For all quantitative studies, a level of evidence was assigned. Various measurements are used to determine the effectiveness of collaborations, for example, hospital admissions and professionals' job satisfaction. Case management as person-centred care for defined patient groups is a central aspect of all identified collaborations between general practitioners and social workers.

CONCLUSION

This scoping review showed evidence for benefits on behalf of patients, professionals and healthcare systems by collaborations between general practitioners and social workers, yet more rigorous research is needed to better understand the impact of these collaborations.

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New conversations between old players? The relationship between general practice and social care

Purpose

– With the advent of Clinical Commissioning Groups, the English health system has abolished more managerially led Primary Care Trusts and given greater responsibilities to groups of local general practitioners (GPs). As with all major changes, this brings both opportunities and risks, and the authors know relatively little about what impact this might have on relationships between the NHS and local government. Against this background, the purpose of this paper is to report key findings from a scoping review commissioned by the National Institute of Health Research School for Social Care Research in order to summarise learning from recent literature.

Design/methodology/approach

– The paper is based on a review of the literature on older people’s services and the relationship between general practice and adult social care, published in the UK from 2000 onwards.

Findings

– Despite the longstanding nature of the issues at stake, the review identified only nine relevant studies. These were of mixed quality, and tended to focus on lessons learned from the late 1990s/early 2000s rather than more recent reforms. Overall, these studies suggest similar barriers to those identified in previous policy contexts, and there is a strong sense of relationships starting from a low base (hence the title of our title of “new conversations between old players”).

Research limitations/implications

– This review is based on literature on older people’s services published since 2000 – so only provides a snapshot of the issues at stake. However, it confirms the relatively limited nature of the evidence base and the need for new research to help shape future policy and practice.

Originality/value

– Despite the central contribution of GPs, the authors still know relatively little about the relationship between general practice and adult social care. Reviewing previous literature (however, limited) is crucial to current attempts to develop more effective joint working at local level.

Going round in circles? Joint working between primary health and social care

Purpose

– The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future.

Design/methodology/approach

– This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government.

Findings

– PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures.

Research limitations/implications

– Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture.

Originality/value

– This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

Modernising social care services for older people: scoping the United Kingdom evidence base

In common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.

Clustering and inertia: structural integration of home care in Swedish elderly care

Purpose

To study the design and distribution of different organizational solutions regarding the responsibility for and provision of home care for elderly in Swedish municipalities.

Method

Directors of the social welfare services in all Swedish municipalities received a questionnaire about old-age care organization, especially home care services and related activities. Rate of response was 73% (211/289).

Results

Three different organizational models of home care were identified. The models represented different degrees of integration of home care, i.e. health and social aspects of home care were to varying degrees integrated in the same organization. The county councils (i.e. large sub-national political-administrative units) tended to contain clusters of municipalities (smaller sub-national units) with the same organizational characteristics. Thus, municipalities' home care organization followed a county council pattern. In spite of a general tendency for Swedish municipalities to reorganize their activities, only 1% of them had changed their home care services organization in relation to the county council since the reform.

Conclusion

The decentralist intention of the reform—to give actors at the sub-national levels freedom to integrate home care according to varying local circumstances—has resulted in a sub-national inter-organizational network structure at the county council, rather than municipal, level, which is highly inert and difficult to change.

Developing homelessness prevention practice: combining research evidence and professional knowledge

This paper presents recommendations of three kinds for the development of homelessness prevention: for practice changes, for the concerted development of evidence on the effectiveness of different measures, and for a more systematic approach to the identification and dissemination of good practice. The recommendations were developed through consultation with health-care, social service and housing provider staff. They were asked to comment on the results of a study of 131 newly homeless people, which showed that there were five prevalent 'packages of reasons' that created distinctive 'pathways' into homelessness and concluded that some cases were preventable. This article outlines the principles of homelessness prevention and recent British policy initiatives in the field, summarises the research methodology and relevant findings, and describes the consultation. The final section discusses the discrepancy between the high priority that homelessness prevention currently receives and the primitiveness of both the evidence base and the arrangements for good practice dissemination.