A lack of coordination between primary and community care services is leading to ‘substandard care and missed opportunities’ for home or community-based treatments, a House of Lords committee has found.
In its report – called Patients at the centre: integrating primary and community care – the Integration of Primary and Community Care Committee cited a number of issues hampering service coordination, leading to ‘undue strain on hospitals that are already overstretched’.
For example, overall workforce shortages are making it harder for primary care teams to spend time on ‘proactive integration efforts’, according to the report. This, it said, was ‘creating a vicious cycle, unless staff feel empowered to find new ways of working in response to need’.
The report, published last week, was compiled following a select committee inquiry that heard from various healthcare professionals and academics, some of whom highlighted a lack of career progression as a barrier to service integration.
For example, Claire Goodman, professor of health care research at University of Hertfordshire and a fellow of the Queen’s Nursing Institute (QNI), cited community nursing, where nurses are faced with a choice between management, which is ‘not necessarily what people want’, or the ‘crowded arena’ of specialist jobs.
According to the report, this lack of opportunity for progression contributes to people leaving the workforce and reduces the incentive to learn new skills among those who remain – ultimately undermining integration strategies.
Another issue highlighted by witnesses was burnout. Sally Kendall, professor of community nursing and public health at Kent University, told the committee that the visible pressures in community work – including long hours, stress and modest pay – have diminished the appeal of university programmes.
Burnout, therefore, is making it harder to attract new recruits to community disciplines already short of staff.
The report makes a number of recommendations, including the exploration of different ownership models for GP practices to ‘facilitate more joined-up and better care’.
The committee also argues that training staff to work across multiple clinical disciplines would make integration easier, since they currently spend more time meeting everyday demand rather than implementing new integration strategies.
A spokesperson for the QNI acknowledged that healthcare services in the community and primary care are unlikely to have the capacity to devote staff to proactive integration efforts – particularly smaller organisations focused on frontline care delivery.
The spokesperson said: ‘Where workforce shortages already exist, this is unlikely to be a priority unless further investment is identified. And, while there are many career pathways in community nursing, these may not always support or reflect an integration agenda.’
As a potential solution, integrated care boards (ICBs) should ‘look for bottlenecks and opportunities in the health and care provider system’, suggested the QNI.
‘It is likely that some ICBs will be more innovative than others and it is therefore important that they share this innovation with other areas,’ the spokesperson added.
They also pointed out that the QNI and NHS Confederation have created a national network of ICB chief nurses, which represents ‘one way that voluntary organisations are helping to support the integration agenda’.
‘Nurses are in a unique position to see where advances can be made, and it is crucial that the nursing voice is heard if we are to see services develop and achieve more integrated and person-centred care,’ the QNI spokesperson said.
Baroness Pitkeathley, chair of the Integration of the Primary and Community Care Committee, said a lack of coordination between primary and community care services ‘means patients are receiving sub-standard care and missing out on many services which could help them by ensuring they receive treatment in their own homes or community, without putting extra strain on beleaguered hospitals’.
She added: ‘We need more joined-up care, and more focus on preventative services if the NHS is going to be able to address the problems posed by the growing number of people in our society with multiple health issues which need complex and continuous care.’
She cited the need for ‘more flexible systems, better data sharing, shared training of staff, good leadership and mutual respect between the many different professions in the system’.
‘The reward will be better value for money, a more efficient system and above all, better outcomes for patients,’ said Baroness Pitkeathley.
A version of this article was first published by Pulse’s sister title Nursing in Practice
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The biggest obstacle to integrated working locally is Community Nurse management. Until that is changed it wont happen.