GPs will challenge social care professionals on how well their patients’ needs are being met as part of family doctors’ new role overseeing health and social care for people with complex needs.
That was the message from NHS England, following the announcement of changes to the GP contract in 2014-15 that will see them take responsibility for developing and reviewing personalised plans covering health and social care for patients with complex needs.
NHS England, which is leading the implementation, said this would not reduce councils’ responsibility for “meeting, assessing and reviewing the social care needs of people in their area”. However, a spokesperson added: “We expect GPs to take a more proactive role in ensuring local authorities responsibilities are carried out for their individual patients. At a practical level this means undertaking a more systematic approach to ensuring their patients’ needs are met and connecting with appropriate social care professionals to ensure this is the case.”
The news came as a study found that relationships between social workers and GPs were often characterised by a lack of mutual understanding of each other’s roles and responsibilities.
Past attempts to engender joint working between GPs and social workers, or joint planning between practices and local authorities, have foundered because of lack of trust, and the use of different eligibility criteria and catchment areas for services.
The study, by Birmingham University’s Health Services Management Centre, examined nine pieces of research into the relationship between GPs and adult social care carried out since 2000. It also conducted interviews with 10 stakeholders about the impact on joint working of the Health and Social Care Act 2012, which vested NHS commissioning responsibility in GP-led clinical commissioning groups.
“Overall, the review found that relationships between general practice and social care are often starting from a relatively low base,” said lead author Jon Glasby, director of the Health Services Management Centre.
The report echoes the findings of a study by social care consultancy iMPOWER last year, which found that dysfunctional relationships between GPs and social workers were driving up demand for residential care. GPs influenced people to enter residential care prematurely based on their lack of knowledge of the alternatives, but iMPOWER found that social workers and local authorities had not done enough to forge relationships with family doctors.
The Birmingham study, which was commissioned by the government-funded School for Social Care Research at the National Institute for Health Research, identified the following success factors for joint working:
- Having time and space to develop good relationships;
- Trust in and awareness of each other’s roles;
- Shared priorities and outcomes;
- Appropriate practical support for joint working.
However, it found little evidence in the literature on the costs or savings of joint working between GPs and social services.
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I am beginning to think I sound like one of those people who always say – back in the day. However do feel that there was so much good practice both in the 80s and the early 90’s. Where I worked there were successful GP attached social workers and also social workers were allocated a GP practice and each week would attend one of the GP practice team meetings. Also the doors of social services were opened and GPs came and visited. I recall one GP saying that in 10 years of literally working next door to the social services office he had never been in. Not surprisingly most problems were solved in this way.