Skip to main content

Main menu

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • Outreach
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
    • Top 10 Research Articles of the Year
  • SPECIAL ISSUES
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
  • CONFERENCE
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Alerts

Search

  • Advanced search
Intended for Healthcare Professionals
BJGP Open
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
BJGP Open
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • Outreach
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
    • Top 10 Research Articles of the Year
  • SPECIAL ISSUES
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
  • CONFERENCE
Practice & Policy

Integrating primary care and social services for older adults with multimorbidity: policy implications

Sam Hodgson, Glenn Simpson, Paul Roderick, Hazel Everitt, Paul Little, Miriam Santer and Hajira Dambha-Miller
BJGP Open 2021; 5 (4): BJGPO.2021.0035. DOI: https://doi.org/10.3399/BJGPO.2021.0035
Sam Hodgson
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: samcbhodgson@gmail.com
Glenn Simpson
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul Roderick
2Department of Population Health, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hazel Everitt
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul Little
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Miriam Santer
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hajira Dambha-Miller
1Primary Care Research Centre, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading
  • Integrated care
  • older adults
  • multimorbidity
  • primary care
  • social services
  • general practice

Introduction

Over the next 20 years, the proportion of over-65s in the UK will rise by a quarter,1 around two-thirds of whom will live with multimorbidity (multiple long-term conditions).2 This change in demographic is likely to lead to a significant growth in care needs,3 further increasing demand on primary care and social services. In response, policymakers have been trying to accelerate the drive towards integrated care4 to deliver service efficiencies, cost savings and, concomitantly, improvements in outcomes for patients and service users. To this end, a variety of integrated care pilots have been trialled.4 There have been concerns that some of these testbeds have been rolled out nationally without a strong evidence base or comprehensive evaluation, for example, ’social prescribing’ initiatives.5 This has led to uncertainty around the efficacy of integrated care initiatives, and no consensus on how best to integrate primary care and social services for older adults with multimorbidity.

To address this gap in the evidence base, we carried out a mixed methods programme of research. This included a scoping review of the literature,6 and a qualitative interview study to elicit key stakeholder views on drivers and barriers to integration of primary care and social services in England. Stakeholders included patients, care service users, carers, primary and secondary care clinicians, social prescribers, community nurses, social workers, voluntary sector workers, and multiple other relevant individuals.7 We used Valentijn’s Rainbow Model of Integrated Care8 as an analytical and spatial lens to interrogate and understand both the literature we identified and the empirical data derived from the semi-structured interviews. This conceptual framework describes integration occurring at and across a range of scales: the whole system level (macro-level integration); the organisational and professional level (meso-level); and the level of clinical and service integration (micro-level).

In this article, we summarise our key findings and propose policy learning points.

Key findings and recommendations

It is increasingly recognised that, to be effective, comprehensive health and social care integration must occur across multiple scales, joining up care both vertically (from the micro- to macro-level) and horizontally among the range of service providers.9,10 In practice, our work showed that efforts to drive forward integration are mainly focused on two scales: first, micro-scale clinical initiatives aimed to integrate care at the point of delivery, for example by having a social worker employed in a local emergency department; second, to a lesser extent, integration is also focused on the meso-level, in the form of interprofessional collaboration and joint working arrangements between organisations. An example of integration at this scale is roles jointly funded by both health and social care. While it has long been postulated that a whole-system approach is necessary to address the needs of older adults with multimorbidity,10 there is limited research evidence of multi-level vertical and horizontal integration across service providers in an English context.9 Currently, health and social care in England is delivered by separate organisations with striking differences in funding, political oversight, and delivery models; for example, health care is free at the point of delivery, but social care is not. In this context, we argue that there is a need to increase macro-scale integration at higher organisational and strategic levels, involving multiple providers, including the private and voluntary sectors.

When attempting to integrate health and social care, a critical factor that is often overlooked is the lack of time given to integrated care programmes to establish an effect. Although there have been calls for integrated care programmes to be given time to mature,11 implementation has repeatedly taken place over relatively short-term periods.12 For example, ‘Vanguard’ sites were established in England in 2015, quickly followed by interventions such as ‘social prescribing’, ‘care navigation’, and then the Integrated Care Systems programme.12 Significantly, none of these underwent thorough evaluation prior to national rollout.5,13 Furthermore, integration has been a challenge in the context of a repeated ’churn’ of new policy programmes, leadership figures, organisational structures, and funding streams. This highlights the challenge faced by policymakers between encouraging innovation while allowing time for new models of integrated care to establish, mature, and potentially reach operational efficiency prior to evaluation. There is a need to work with policy communities to use available evidence as best as possible to achieve this.

Stakeholder experiences and published literature consistently highlight enablers of integrated care which could be harnessed by policymakers.4,11,14 First, although the pivotal role of dynamic leaders in driving and sustaining integrated working is repeatedly emphasised in earlier research,9 policymakers to date have given limited attention to this enabler of integrated care. Embedding leadership systematically presents challenges, in particular sustainability of change when dynamic leaders become less dynamic or leave their role, but one way of achieving this could be through wider rollout of local ’champion‘ roles and leadership training programmes. Second, the development of ’link‘ or ‘interface‘ roles — such as ’Care Navigators’ — who are able to provide integration between existing services potentially limits the need for wider service re-design at the system or organisational levels by enabling integration within existing models of care.14 Their location at potential ‘pinch points’ in care systems enables care transitions across sectoral boundaries and offers patients, care service users, and carers support in navigating complex care systems. Third, co-location and shared working spaces can facilitate interprofessional relationship-building and trust, which are essential to establishing sustainable, integrated working arrangements and multidisciplinary teams. Harnessing the potential of these enablers within whole-system integration might allow policymakers to overcome historic tensions between central policy and local service delivery agendas, and in doing so facilitate development of better models of integrated care.

Conclusion

We identified common themes in the published literature and stakeholder interviews highlighting drivers of, and barriers to, integration between primary care and social services for older adults with multiple long-term health conditions. In the context of an increasingly ageing population with growing care needs,3 learning from past integration experiences is essential to addressing future challenges. A critical issue for systems of integrated care is to deliver holistic, whole-system structures, which require high-level policy initiatives while allowing flexibility for local solutions. This can only be achieved with sufficient political will and urgent action.

Notes

Funding

The Southampton Primary Care Research Centre is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. HDM is an NIHR Clinical Lecturer and received an NIHR SPCR grant for this work (reference: SPCR2014-10043). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

HDM is the Editor-in-Chief of BJGP Open, but had no involvement in the peer review process or decision on this manuscript. SH is a member of the editorial board of BJGP Open. Similar to HDM, SH was not involved in the review of this manuscript in any way.

Competing interests

The authors declare that no competing interests exist.

The authors report no conflicts of interest in this work

Acknowledgments

The authors thank all volunteers, participants, and PPI representatives who contributed to this study.

  • Received February 26, 2021.
  • Accepted March 25, 2021.
  • Copyright © 2021, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

References

  1. 1.↵
    1. Office for National Statistics, UK Government
    (2018) Living Longer. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2019-03-15. 20 May 2021.
  2. 2.↵
    1. Kingston A,
    2. Robinson L,
    3. Booth H,
    4. et al.
    (2018) Projections of multi-morbidity in the older population in England to 2035: estimates from the population ageing and care simulation (PACSim) model. Age Ageing 47(3):374–380, doi:10.1093/ageing/afx201, pmid:29370339.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Kingston A,
    2. Comas-Herrera A,
    3. Jagger C,
    4. MODEM project.
    (2018) Forecasting the care needs of the older population in England over the next 20 years: estimates from the population ageing and care simulation (PACSim) modelling study. Lancet Public Health 3(9):e447–e455, doi:10.1016/S2468-2667(18)30118-X, pmid:30174210.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Erens B,
    2. Wistow G,
    3. Mays N,
    4. et al.
    (2019) Can health and social care integration make long-term progress? Findings from key informant surveys of the integration pioneers in England. J Integr Care 28(1):14–26, doi:10.1108/JICA-05-2019-0020.
    OpenUrlCrossRef
  5. 5.↵
    1. Husk K,
    2. Elston J,
    3. Gradinger F,
    4. et al.
    (2019) Social prescribing: where is the evidence? Br J Gen Pract 69(678):6–7, doi:10.3399/bjgp19X700325, pmid:30591594.
    OpenUrlFREE Full Text
  6. 6.↵
    1. Dambha-Miller H,
    2. Simpson G,
    3. Hobson L
    (26 Feb 2021) Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review [Preprint, BMC Geriatrics]. https://doi.org/10.21203/rs.3.rs140720/v1. 26 Feb 2021.
  7. 7.↵
    1. Dambha-Miller H,
    2. Simpson G,
    3. Hobson L,
    4. et al.
    (2021) Integrating primary care and social services for older adults with multimorbidity: a qualitative study [Preprint]. medRxiv doi:10.1101/2021.01.30.21250563.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Valentijn PP,
    2. Schepman SM,
    3. Opheij W,
    4. Bruijnzeels MA
    (2013) Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care 13, doi:10.5334/ijic.886, pmid:23687482. e010.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Humphries R
    (2015) Integrated health and social care in England — progress and prospects. Health Policy 119(7):856–859, doi:10.1016/j.healthpol.2015.04.010, pmid:25981590.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Ham C
    (2010) Integrated care: what is it? Does it work? What does it mean for the NHS?. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/integrated-care-summary-chris-ham-sep11.pdf. 20 May 2021.
  11. 11.↵
    1. Shortell SM,
    2. Addicott R,
    3. Walsh N,
    4. Ham C
    (2015) The NHS five year forward view: lessons from the United States in developing new care models. BMJ 350, doi:10.1136/bmj.h2005, pmid:25899794. h2005.
    OpenUrlFREE Full Text
  12. 12.↵
    1. Collins B
    (2016) New Care Models: Emerging Innovations in Governance and Organisational Form. The King's Fund. https://www.kingsfund.org.uk/publications/new-care-models. 20 May 2021.
  13. 13.↵
    1. National Audit Office
    (2017) Health and Social Care Integration – National Audit Office Report 2017. ISBN 9781786041043. http://www.nao.org.uk/report/health-and-social-care-integration/. 20 May 2021.
  14. 14.↵
    1. Sadler E,
    2. Potterton V,
    3. Anderson R,
    4. et al.
    (2019) Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis. PLoS One 14(5), doi:10.1371/journal.pone.0216488, pmid:31083707. e0216488.
    OpenUrlCrossRefPubMed
Back to top
Previous ArticleNext Article

In this issue

BJGP Open
Vol. 5, Issue 4
August 2021
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending BJGP Open.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Integrating primary care and social services for older adults with multimorbidity: policy implications
(Your Name) has forwarded a page to you from BJGP Open
(Your Name) thought you would like to see this page from BJGP Open.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Integrating primary care and social services for older adults with multimorbidity: policy implications
Sam Hodgson, Glenn Simpson, Paul Roderick, Hazel Everitt, Paul Little, Miriam Santer, Hajira Dambha-Miller
BJGP Open 2021; 5 (4): BJGPO.2021.0035. DOI: 10.3399/BJGPO.2021.0035

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Integrating primary care and social services for older adults with multimorbidity: policy implications
Sam Hodgson, Glenn Simpson, Paul Roderick, Hazel Everitt, Paul Little, Miriam Santer, Hajira Dambha-Miller
BJGP Open 2021; 5 (4): BJGPO.2021.0035. DOI: 10.3399/BJGPO.2021.0035
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Introduction
    • Conclusion
    • Notes
    • References
  • Info
  • eLetters
  • PDF

Keywords

  • Integrated care
  • older adults
  • multimorbidity
  • Primary care
  • social services
  • general practice

More in this TOC Section

  • Telehealth and primary care: a special collection from BJGP Open
  • Reconsidering the Levesque framework: a social work perspective for healthcare professionals
  • The impact of remote consultations on brief conversations in general practice
Show more Practice & Policy

Related Articles

Cited By...

Intended for Healthcare Professionals

@BJGPOpen's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Latest articles
  • Authors & reviewers
  • Accessibility statement

RCGP

  • British Journal of General Practice
  • BJGP for RCGP members
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP Open
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP Open: research
  • Writing for BJGP Open: practice & policy
  • BJGP Open editorial process & policies
  • BJGP Open ethical guidelines
  • Peer review for BJGP Open

CUSTOMER SERVICES

  • Advertising
  • Open access licence

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Open Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: bjgpopen@rcgp.org.uk

BJGP Open is an editorially-independent publication of the Royal College of General Practitioners

© 2023 BJGP Open

Online ISSN: 2398-3795