How can GPs and community health services work more effectively together?

On 23 October 2014, NHS England Chief Executive Simon Stevens published a new 5-year plan for the NHS. Highlighting the challenges facing the NHS associated with an ageing population, the document argues: ‘The traditional divide between primary care, community services, and hospitals — largely unaltered since the birth of the NHS — is increasingly a barrier to the personalised and coordinated health services patients need.’

It then goes on to discuss what models of care might look like under the plan. The focus is on integration and collaboration, eschewing further structural change but highlighting the potential of new service models which bring GPs together with a wide range of other providers, including community, social, and acute care services. Moving care closer to patients’ homes is highlighted, with vulnerable patients cared for proactively by multidisciplinary teams. None of this is new. GP fundholders pioneered better access to diagnostic tests and outreach by hospital consultants in the 1990s, while the 2000s brought Community Matrons, Virtual Wards, and Models of Case Management. However, integration between primary and community health services (CHS) has not been easy to achieve, and it is far from clear that such service models can, in fact, reduce costs.

Against this background, an extensive review of existing literature was conducted to explore what factors should be taken into account in planning for primary care and CHS to work more effectively together. Starting with interdisciplinary healthcare teamworking (the micro-level), evidence was examined across all levels of the current care system to account for the diversity of the services.