School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK.
Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK.
BMC Prim Care. 2023 Aug 30;24(1):168. doi: 10.1186/s12875-023-02124-3.
As integrated care systems are embedded across England there are regions where the integration process has been evaluated and continues to evolve. Evaluation of these integrated systems contributes to our understanding of the challenges and facilitators to this ongoing process. This can support integrated care systems nationwide as they continue to develop. We describe how two integrated care partnerships in different localities, at differing stages of integration with contrasting approaches experienced challenges specifically when integrating with primary care services. The aim of this analysis was to focus on primary care services and how their existing structures impacted on the development of integrated care systems.
We carried out an exploratory approach to re-analysing our previously conducted 51 interviews as part of our prior evaluations of integrated health and care services which included primary care services. The interview data were thematically analysed, focussing on the role and engagement of primary care services with the integrated care systems in these two localities.
Four key themes from the data are discussed: (i) Workforce engagement (engagement with integration), (ii) Organisational communication (information sharing), (iii) Financial issues, (iv) Managerial information systems (data sharing, IT systems and quality improvement data). We report on the challenges of ensuring the workforce feel engaged and informed. Communication is a factor in workforce relationships and trust which impacts on the success of integrated working. Financial issues highlight the conflict between budget decisions made by the integrated care systems when primary care services are set up as individual businesses. The incompatibility of information technology systems hinders integration of care systems with primary care.
Integrated care systems are national policy. Their alignment with primary care services, long considered to be the cornerstone of the NHS, is more crucial than ever. The two localities we evaluated as integration developed both described different challenges and facilitators between primary care and integrated care systems. Differences between the two localities allow us to explore where progress has been made and why.
随着综合护理系统在英格兰各地的建立，有些地区已经对整合过程进行了评估，并在继续发展。对这些综合系统的评估有助于我们了解这一持续过程中的挑战和促进因素。这可以支持全国范围内的综合护理系统，因为它们在继续发展。我们描述了两个不同地区的综合护理伙伴关系，它们在整合程度和方法上存在差异，在与初级保健服务整合时遇到了具体的挑战。本分析的目的是关注初级保健服务以及其现有结构如何影响综合护理系统的发展。
我们对之前进行的 51 次访谈进行了探索性的重新分析，这些访谈是我们之前对综合卫生和护理服务的评估的一部分，包括初级保健服务。对访谈数据进行了主题分析，重点关注这两个地区的初级保健服务在综合护理系统中的作用和参与情况。
从数据中讨论了四个关键主题：（i）劳动力参与（参与整合），（ii）组织沟通（信息共享），（iii）财务问题，（iv）管理信息系统（数据共享、IT 系统和质量改进数据）。我们报告了确保劳动力感到参与和知情的挑战。沟通是劳动力关系和信任的一个因素，这会影响整合工作的成功。财务问题突显了在将初级保健服务设置为独立企业时，综合护理系统所做预算决策之间的冲突。信息技术系统的不兼容性阻碍了护理系统与初级保健的整合。
综合护理系统是国家政策。它们与长期以来被认为是国民保健制度基石的初级保健服务的结合比以往任何时候都更加重要。我们评估的两个地区在整合过程中都描述了初级保健和综合护理系统之间的不同挑战和促进因素。两个地区之间的差异使我们能够探索已经取得进展的地方以及原因。
