General practice and adult social care: friends or foe?

Citation

Glasby, J., Miller, R. and White, S. (2015), "General practice and adult social care: friends or foe?", Journal of Integrated Care, Vol. 23 No. 2. https://doi.org/10.1108/JICA-01-2015-0009

General practice and adult social care: friends or foe?

Article Type: Editorial From: Journal of Integrated Care, Volume 23, Issue 2.

From the late 1940s closer collaboration between social work and general medical practice has been advocated as a means of improving primary health care. Despite the persuasive rhetoric of its advocates and the successful completion of several demonstration projects of attachment of social workers to group medical practices, the majority of general practitioners and social workers in the field remain unconvinced, not so much of the potential but of the possibility of inter-occupational collaboration (Huntingdon, 1981, p. 1).

Following the widespread changes introduced in the English NHS as a result of the Health and Social Care Act 2012, one thing seems certain. Whatever does or does not happen next, there is going to be an even more significant role for general practice in particular and for primary care more generally. With the abolition of Primary Care Trusts (PCTs) and the creation of general practitioner (GP)-led Clinical Commissioning Groups (CCGs), GPs are central not just to meeting individual health needs, but also to commissioning services for the whole of the local population. Following a significant period of time when policy has sought to separate the purchasing and provision of care, this focus on GPs as both providers and commissioners of services is interesting to say the least.

As a result of these changes, the focus of local relationships between health and social care will be on GPs and on adult social services. Again, this feels different to the more recent past – when relationships often focused on more managerially led PCTs and the local authority (perhaps to the exclusion of GPs). On the one hand, this represents a significant opportunity to re-evaluate and rethink local services, building on the clinical expertise, local knowledge and trusted status of GPs in a way that proved difficult under previous structures. At the same time, the abolition of PCTs has created major upheavals in local relationships and revealed a series of underlying tensions. For all their expertise and experience, many GPs rarely come into contact with adult social care services, and levels of understanding of each other’s roles and responsibilities are sometimes limited.

In other parts of the UK, these issues are just as important (even though there isn’t necessarily the equivalent of a “CCG”). Both GPs and social workers are often the “entry point” into the health and social care systems, and – despite limited experience of working together in many local areas – actually have much in common with each other. This has been forcefully demonstrated by Professor Bob Hudson, who has produced the following table as a way of illustrating the significant overlaps and untapped potential in terms of joint working between general practice and adult social care (Table I).

Table I Potential for joint working between GPs and social workers

Against this background, this special edition builds on an initial scoping review commissioned by the NIHR School for Social Care Research (Glasby et al., 2013) which sought to collate the existing evidence on relationships between general practice/primary care and adult social care. Entitled “New conversations between old players”, the review is summarised later in this special edition – but essentially concluded that we know very little about this fundamental relationship (and that the relatively small amount of evidence which exists tends to derive from previous reforms in the late 1990s and early 2000s). The quality of this evidence was also very mixed, and the review concluded that existing relationships may well be starting from a low base.

In response to this review, the University of Birmingham’s Health Services Management Centre held a one-day national workshop in February 2015 in order to bring together policy makers, senior leaders, practitioners and researchers. This was jointly badged with The College of Social Work and the Royal College of General Practitioners, who had recently been working together to draw attention to the importance of joint working, to showcase examples of good practice and to use their status and networks as national professional bodies to model and promote good practice (College of Social Work/Royal College of General Practitioners, 2014). Following on from the workshop, this special edition is jointly badged by the Journal and by The College of Social Work, with the College’s Chief Executive, Annie Hudson, also contributing as an author.

We begin with a summary of the main themes from the School of Social Care Research scoping review discussed above. Despite the importance of relationships between general practice and adult social care, we still know relatively little about this crucial area of policy and practice (in terms of recent research, at least), and the existing literature has a number of limitations. Two of the exceptions to this overall state of affairs are Anna Coleman and Caroline Glendinning, authors of our second paper. Both were instrumental in much of the research and commentary that was published on this topic in the late 1990s and early 2000s (see, e.g. Glendinning et al., 2001a,b, 2002; Rummery and Glendinning, 2000), and this expertise is supplemented by data from much more recent research into the development of CCGs. By focusing on previous PCTs and current CCGs, their paper is able to draw out key lessons for the current policy and practice context, making sure that we don’t neglect the lessons from previous experiments and ways of working. This is crucial learning – and has the potential to help us refrain from reinventing the wheel by building on what did and didn’t work when such issues were being debated previously.

After this, Catherine Mangan, Robin Miller and Carol Ward report on the initial findings of a project exploring the inter-professional issues in general practice and adult social care teams working together. Whilst such issues have been identified internationally as key to better collaboration in primary care settings, they have been relatively neglected in the UK in the context of integrated working between these two services. Based on focus groups of professionals working in general practice and adult social care teams, the research found a lack of awareness from general practice about the role and competence of adult social care professionals. Old stereotypes continued to be expressed and many social workers felt that GPs had more power and status without being clear exactly why. Positive examples of integrated working were often related to personal styles and relationships despite, rather than because of, system changes.

Such themes are then developed in two complementary papers by Angela Beacon and by Alan Lotinga, setting out personal reflections, lessons learned and potential future directions of travel from their experience of working at the interface between general practice and adult social care in Manchester and Birmingham, respectively. Whereas Angela’s case study focuses on the detail of the local project, Alan’s contribution places the Birmingham story in a broader context, seeking to illustrate the way in which local debates about joint working are influenced by broader relationships and by the history and culture of local services.

Finally, Annie Hudson, Chief Executive of The College of Social Work, offers some personal reflections on joint working between general practice and adult social care, building on national collaboration with the Royal College of General Practitioners as well as on her own experience as a former Director of Adult Social Services and a Director of Children’s Services. In particular, she focuses on the contribution of social work as a profession distinct from broader social care, and the danger that current debates adopt a more NHS-dominated approach which potentially under-recognises the potential of social work to contribute to a different, more person-centred notion of integration.

As always, we hope that this mix of research, policy and practice expertise makes a useful contribution to local services and to national policy makers trying to make a practical difference to joint working. One of the strengths of the Journal of Integrated Care has always been its ability to bring together contributors from different backgrounds to shed light on current “hot topics”, and we hope that this special edition is no exception.

Jon Glasby, Robin Miller and Sue White

References

College of Social Work/Royal College of General Practitioners (2014), GPs and Social Workers: Partners for Better Care – Delivering Health and Social Care Integration Together, The College of Social Work and the Royal College of General Practitioners, London

Glasby, J., Miller, R. and Posaner, R. (2013), New Conversations Between Old Players? The Relationship Between General Practice and Social Care in an Era of Clinical Commissioning, School for Social Care Research, London

Glendinning, C., Abbott, S. and Coleman, A. (2001a), “‘Bridging the gap’: new relationships between primary care groups and local authorities”, Social Policy and Administration, Vol. 35 No. 4, pp. 411-425

Glendinning, C., Coleman, A., Shipman, C. and Malbon, G. (2001b), “Primary care groups: progress in partnerships”, British Medical Journal, Vol. 323 No. 7303, pp. 28-31

Glendinning, C., Coleman, A. and Rummery, K. (2002), “Partnerships, performance and primary care: developing integrated services for older people in England”, Ageing & Society, Vol. 22, pp. 185-208

Hudson, B. (2000), “Social services and primary care groups: a window of collaborative opportunity?”, Health and Social Care in the Community, Vol. 8 No. 4, pp. 242-250

Hudson, B., Hardy, B., Henwood, M. and Wistow, G. (1997), “Strategic alliances: working across professional boundaries – primary health care and social care”, Public Money and Management, Vol. 17 No. 4, pp. 25-30

Hudson, B., Lewis, H., Waddington, E. and Wistow, G. (1998), Pathways to Partnership: The Interface between Social Care and Primary Health Care: National Mapping Exercise, Nuffield Institute for Health/Association of Directors of Social Services, Leeds

Huntingdon, J. (1981), Social Work and General Medical Practice: Collaboration or Conflict? Allen & Unwin, London

Rummery, K. and Glendinning, C. (2000), Primary Care and Social Services, Radcliffe Medical Press, Abingdon