Use existing staff to drive integrated care, says report

BMJ 2016; 353 doi: (Published 30 June 2016) Cite this as: BMJ 2016;353:i3661
  1. Gareth Iacobucci
  1. The BMJ

NHS and local government leaders should not automatically create new roles to deliver integrated care as there is “limited evidence” to support the creation of these jobs, a new report has advised.

The report1 by the King’s Fund examined the evidence for creating new positions to help drive integration across health and social care in line with national government policy.

It analysed new roles ranging from co-ordinators and case managers—specifically appointed to drive integrated care—to extended support workers or personal assistants—appointed to build on existing roles to facilitate integration.

The analysis found little evidence that creating new roles was an effective way of breaking down cultural barriers between organisations or reducing costs. It suggested that working with the existing workforce to create “more flexible and multiskilled teams that can work across boundaries” may be a more effective strategy.

“New roles to support integrated care are only effective when they are part of a system wide process of integration,” the report said.

It added, “New roles may be needed in some cases; however, the need for such roles should be demonstrated rather than assumed, as part of a broader plan for integrating care.”

The report said that successful integrated care schemes were characterised by sharing and distribution of skills across whole systems, good engagement of the workforce from the outset on the aims of integration, and staff being enabled to take a lead in coming up with solutions that work for patients and the public.

It also stressed that wider organisational support from management was “essential” for creating sustainable and high quality integrated care plans.

Professional boundaries should also be acknowledged as these can “serve to build trust and respect, which in turn can lead to greater role flexibility,” it added.

The report, commissioned by the Local Government Association (LGA) and NHS Employers, concluded that organisations should address “the fundamentals” of integration before creating new roles.

Helen Gilburt, the report’s lead author and fellow at the King’s Fund said, “While the aim of creating a more flexible and multiskilled workforce to provide more holistic care is paramount, rather than create a new role, it is much more compelling to utilise the existing skills of the workforce more effectively and engage staff in identifying and implementing workforce solutions themselves.’

Danny Mortimer, chief executive of NHS Employers said, “We are committed to working with the LGA and our colleagues in social care to ensure we design services and roles which provide the best care to our communities and citizens. It is vital that we understand and rapidly apply the lessons identified by this report.”


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