Integration, integration, integration might be the word from the top, but on the ground it’s often a dirty one.
A session entitled ‘GPs and social workers: old friends or old foes?’ at the School for Social Care Research annual conference this week shed light on some of the problems.
Not least is the fact that the evidence is very sketchy about whether integration leads to better outcomes anyway. When Robin Miller, senior fellow at the University of Birmingham’s health services management centre, and colleagues started investigating the issue they found only nine relevant research studies about the relationship between GPs and social workers published since 2000 – and some of these had been written in the 1990s.
To find out more they set up focus groups comprising staff in GP surgeries and adult social work teams. They discovered that it’s the basic, practical details that are the downfall of integrated working: for example, how do GPs go to case co-ordination meetings if they are held during the day when they have clinics to run? And how can the two professions work on a local level when GP practices cover different catchment areas to local authorities and both have different eligibility criteria?
A common problem was not knowing who to contact – in one area only one GP even knew that a single point of access for adult social care existed. As Miller commented, “If they don’t know that, what else don’t they understand?”
The most common experience was one of distance, in both locality and communication terms. In fact, fax seemed to be the preferred choice of communication between the two professions, hardly likely to engender good working relationships.
Although Miller said it was “quite frightening how some of the old stereotypes still exist”, the initial feedback from the focus groups was promising. Both professions reported enjoying the interaction and getting to know how each worked, and finding common feelings. Perhaps integration isn’t such a dirty word after all.