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The purpose of this paper is to explore interprofessional and multidisciplinary working between health and social care practitioners providing services to older people through the prism of how risk is assessed and managed. It proposes that whilst interprofessional and multidisciplinary working is a broad and commonly researched topic, there is a relative paucity of evidence specifically regarding how health and social care practitioners work together across structural, cultural and ideological divides. The study aims to expand the domain of integrated health and social care by including perceptions, understanding and use of the concept of risk by professionals from different disciplines.

This paper is based upon an exploratory study using an interpretivist phenomenological perspective, including 23 semi-structured individual interviews with health and social care practitioners and 2 non-participant observations of multidisciplinary team meetings.

The paper provides empirical insights around the complex dynamics of interprofessional and multidisciplinary working between health and social care practitioners, in particular the saliency of the interconnectedness of individual practitioner Personalities with the Process of interprofessional and multidisciplinary working under the auspices of relevant Policy drivers.

The research was conducted in Wales and, due to the increasingly divergent policy context within the UK, the research results may lack generalisability from a wider UK or international perspective. Therefore, researchers are encouraged to test the propositions of this research further.

The paper includes implications for both interprofessional and multidisciplinary policy and practice with older people. With new models of integrated care being sought, the findings of this study may offer a timely and valuable contribution, particularly from the inclusion of a social care perspective and in better understanding the interconnectedness of practitioner personalities with process and policy.

This paper fulfils an identified need to study the complex dynamics and interconnectedness between health and social care practitioners who work together to provide services to older people.

Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.

Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.

Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.

Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.

This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Consumer‐driven health care (CDHC) has been proposed to reduce the USA health care costs through greater free market economic exposure. The purpose of this paper is to review the USA health care system, insurance plans, and CDHC plan elements and assumptions regarding patients, service providers, and insurers, in order to identify research and social marketing needs of CDHC.

The paper is an assessment of literature from academic and practitioner communities.

Social marketing programs can contribute to preparing consumers and practitioners for CDHC. However, the degree to which CDHC can reduce health care costs is uncertain. More research is needed comparing CDHC plans with traditional plans and comparing CDHC enrollees with enrollees in other types of plans to determine the true benefits and costs of CDHC and to identify consumers' information needs. Research is needed into how to gather and provide understandable health care provider quality and cost‐effectiveness information, and into how current insurers can help consumers make effective CDHC decisions. Research is needed as to how CDHC is perceived by consumers, providers, and insurers, and the use of CDHC reimbursement accounts and their effect on behavior and costs. Research is also needed into which decisions can be made by consumers without specialized professional knowledge. Provider research is needed into outcome risk adjustments, how practitioners view CDHC, how willing practitioners are to participate in a more open‐free market, and how CDHC may affect professional practices.

Insights gained from this paper can contribute to social marketing program designs needed for practitioner and consumer acceptance and effective use of CDHC.

Scholarship has demonstrated important consequences of segregation on health and health care outcomes, yet the mechanisms behind this association remain poorly understood. Several recent studies have shown inequities in the distribution of a wide variety of health-related organizations across urban neighborhoods, which may account for some portion of this negative health association. Though, within this literature, relatively little attention has been given to the distribution of health care facilities in particular.

Here, I consider how segregation is related to the distribution of several auxiliary health care practitioners in a series of spatial regression models of zip codes across the United States using data from the 2010 US Census and County Business Patterns (CBP).

I find that both Black and Latino segregation is negatively related to the density of a number of auxiliary health care practitioners, including mental health providers, dentists, physical/occupational/speech therapists, chiropractors, optometrists, podiatrists, and miscellaneous health care practitioners. However, this association is reduced (in certain instances to non-significance) with the inclusion of socioeconomic indicators, chiefly the percent of college educated individuals and the unemployment rate of the zip code. This is association is reduced for both Black and Latino segregation, with a larger reduction in the size of the effects for Latino segregation.

This research suggests that segregation plays an important role in the distribution of health care facilities, but that policy and public health interventions should focus on the intersection between racial residential segregation and socioeconomic considerations.

Successive policy documents concerning older people's health and well‐being have aimed to improve their care, by raising standards and promoting independence. These policies also emphasise the need for research to prevent disability, and reduce admission to hospitals and long‐term care settings. This paper reports an evaluation in progress of a health technology approach designed to achieve these objectives. An ‘expert system’ is described that is intended to improve older people's access to health and social care information, to enable service providers to review the health and social care needs of older people, and to allow planners to assess the needs of whole populations. The paper ends by inviting discussion and responses from readers of this journal.

The current role of the approved social worker (ASW) will be changed to that of the approved mental health practitioner, who may be a nurse or other mental health professional, if proposed legislation comes into force in England and Wales. This has implications for service users, carers and the mental health workforce. This article draws on literature and a conference discussing this change attended by practitioners and policy‐makers. It considers the complexity of the ASW role and the implications for the AMHP, and sets the related issues in the context of integrated working.

With global migration, the number of ethnic minority and migrant women receiving maternity health care in dominantly Anglo-European societies has increased significantly but they consistently have among the worst pregnancy and maternal outcomes. This paper aims to analyse gaps in structural (migration-related inequalities) and cultural (responsiveness to ethno-cultural practices) competencies among maternal health practitioners in Aotearoa New Zealand (NZ).

Using a semi-structured interview guide, in-depth interviews were conducted with 13 maternal health practitioners in NZ. Data were analysed using a thematic analysis framework.

The results highlight significant barriers around language and communication, cultural stereotyping by professionals, ethnic women’s own constraints around family and cultural expectations and their lack of knowledge about reproductive health. In addition, practitioners’ own ethnic differences are inseparable from their approach to structural and cultural competencies; there were instances of ‘over-’ or ‘under-’ reading of culture, practitioner constructions of ideal pregnancies and anti-racism concerns that shaped maternal care practices that were sensitive to, but also marginalised, ethnic migrant women who attended maternity services.

To the best of the authors’ knowledge, this is the only study in NZ that examines the impact of complex dynamics of migration and culture on knowledge, beliefs and values of practitioners, in context of their own personal biographies. Identifying strategies to improve the way diversity is practiced in hospital settings can be transformational in improving maternal outcomes for ethnic migrant women in NZ.

The purpose of this paper is to discuss the issues relating to getting the right health and social care staff with the right skills in the right place at the right time and at the right price.

Key points arising from several master-classes with health and social care managers, supported by a literature review, generated remarkable insights into health and social care workforce planning and development (WP&D).

Flawed methods and overwhelming data are major barriers to health and social care WP&D. Inefficient and ineffective WP&D policy and practice, therefore, may lead to inappropriate care teams, which in turn lead to sub-optimal and costly health and social care. Increasing health and social care demand and service re-design, as the population grows and ages, and services move from hospital to community, means that workforce planners face several challenges. Issues that drive and restrain their health and social care WP&D efforts are lucid and compelling, which leave planners in no doubt what is expected if they are to succeed and health and social care is to develop. One main barrier they face is that although WP&D definitions and models in the literature are logical, clear and effective, they are imperfect, so planners do not always have comprehensive tools or data to help them determine the ideal workforce. They face other barriers. First, WP&D can be fragmented and uni-disciplinary when modern health and social care is integrating. Second, recruitment and retention problems can easily stymie planners’ best endeavours because the people that services need (i.e. staff with the right skills), even if they exist, are not evenly distributed throughout the country.

This paper underlines triangulated workforce demand and supply methods (described in the paper), which help planners to equalise workloads among disparate groups and isolated practitioners – an important job satisfaction and staff retention issue. Regular and systematic workforce reviews help planners to justify their staffing establishments; it seems vital, therefore, that they have robust methods and supporting data at their fingertips.

This paper stock-takes the latest health and social care workforce planning and development issues.

Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.

Purpose: This chapter examines how healthcare technologies (electronic medical records, personal cell phones, and pagers) help manage patient care work to accelerate processes of communication and blur boundaries between work time and non-work time, thereby revealing dynamics of power as indicated through temporal capital, or the amount of time under an individual’s control.

Method: The data were collected from 35 in-depth semistructured interviews of health practitioners, which included 26 physicians, 7 nurses, and 2 administrators.

Findings: Communication technologies fulfill promises of temporal autonomy and efficiency, but not without cost, particularly as it intersects with organizational/institutional power structures and non-work-related social factors such as pre-existing technological literacy and proficiency. The blurring of work and non-work time gives practitioners perceived higher quality of life while also increasing temporal flexibility and autonomy. The higher up one is in the relevant hierarchy, the more control one has over one’s own time, resulting in higher levels of temporal capital. The power hierarchies serve to complicate the potential recuperation of temporal capital by communication technologies.

Implications: This study uses a critical cultural perspective that takes into consideration structures of institutional power hierarches impact temporal organization through the use of communication technologies by health practitioners. Practitioner-facing research is particularly crucial given the high rates of burnout within the profession and concerns around the well-being of health practitioners, and autonomy and control over one’s time is a factor in work and life satisfaction.