GPs’ views of integration in North West London

Evaluation of the North West London Whole Systems Integrated Care programme

Holly Holder, Gerald Wistow, Matt Gaskins and Judith Smith

The Nuffield Trust and the London School of Economics and Political Science

October 2015

Key points

• GPs in North West London reported that patients experience fragmented care in their area

• Improving relationships across a number of sectors was seen as very important to GPs, as many also reported that, at present, providers do not work together as effectively as is needed

• Workloads in general practice and insufficient support for GPs to work in new ways were identified as barriers to achieving integrated careo Solutions included ensuring GPs had protected time away from

patients to attend multi-disciplinary meetings and developing shared IT systems

Key points (continued)

• ‘GPs at the centre of coordinating care for patients’ was interpreted in a number of ways, and only half of respondents thought it could be achieved via integrated care

• Half of respondents thought that integrated care could improve the quality of care, but only one fifth thought it could make the care system more financially sustainable (both of these are goals of the Whole Systems Integrated Care programme)

• The majority of respondents had heard about the Whole Systems Integrated Care programme, but perceptions of it were varied. Some thought it was an important project, but others felt it was expensive or were unsure about the goal of pooling budgets

What is the Whole Systems Integrated Care programme?

• The Whole Systems Integrated Care (WSIC) programme is a large-scale integrated care scheme operating in North West London, bringing together commissioners and providers from the health, social care, mental health, voluntary and community sectors, across eight local authority/CCG areas

• Nine local initiatives (‘Early Adopters’) were established to pilot and implement the WSIC programme at the local level

• Early Adopter schemes varied in focus and approach but all followed the same overarching principles (as listed in the WSIC Toolkit (2014) http://integration.healthiernorthwestlondon.nhs.uk/)

• One of these principles is to have GPs at the centre of coordinating care

Two levels of operation: pan-NWL and Early Adopters

1. Programme level: pan-NWL collaborative of commissioners and providers

2. Local level: nine pilot initiatives operating across the eight boroughs, known as Early Adopters

SEMI: serious and enduring mental illness (a pan-NWL pilot)

Our evaluation

• The Nuffield Trust and the London School of Economics and Political Science were commissioned by Imperial College Health Partners to undertake an evaluation of the WSIC programme

• Evaluation fieldwork ran between February 2014 and May 2015

• The full report can be accessed at: http://www.nuffieldtrust.org.uk/publications/integrated-care-north-west-london-experience

• Limitations:

• This survey is one element of a wider set of evaluation methodologies

• By nature, these results are a snapshot in time and may not reflect the current situation in North West London

Survey methodology

• Survey of GPs in North West London:

• One GP per practice was invited to participate

• Project managers and CCG leads were asked to circulate an invitation to one GP

in each practice, via an email drafted by the research team

• Purpose: to explore perceptions of the need for integrated care among GPs and their reaction to the approach being taken via the WSIC programme

• Online survey using Survey Monkey

• Data collection: 24 March 2015 – 8 May 2015

• 160 responses received (19 of these were from non-GP practice staff)

• Response rate: 39% (assumes one response per practice)

• Response rate between areas was variable: between 13% and 53%

Profile of respondents

Overall response rate was 39% (assumes one response per practice in North West London)

21.3% of respondents had a formal role in their CCG

Results in this slideshow use data from all respondents, including the 12.5% who participated on behalf of their practice GPs and the 5.6% who did not tell us their role

Which of these best describes your role in the GP practice?

N %

Partner 107 66.9%

Salaried doctor 15 9.4%

Locum 6 3.8%

Registrar 1 0.6%

Other GP 2 1.3%

All GPs 130 81.9%

Other:Practice managerNurseAdministrator

1631

10.0%1.9%0.6%

Unknown 9 5.6%

Total 160  100%

Reflections on the need for integrated care in North West London

GPs felt that patients struggled with service awareness and that providers could work together more successfully

0%

20%

40%

60%

80%

100%

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

The following statements are often used to argue why integrated care is necessary, but may also be barriers to integrated care succeeding. To what extent do you agree or disagree with these statements about your area?

N = 136 – 137

It was reported that there was a need to improve relationships with colleagues in multiple sectors

MH S

ervic

es

Comm

nur

ses

Comm

con

sulta

nts

Hosp

docs

Hosp

disch

arge

team

Rapid

resp

onse

AHPs

Comm

pha

rmac

ists

GPs in

othe

r pra

ctice

s

LA A

SC

LA c

are

man

ager

s

Housin

g

Third

sect

or A

SC

Privat

e ASC

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No improvement needed

Very unimportant

Unimportant

Neither important or unimportant

Important

Very important

How important is it that you improve the relationship you have with the following groups?

N = 127 – 129

MH: mental healthComm: communityHosp: hospitalAHPs: allied health professionalsLA: local authorityASC: adult social care

Wor

kload

s in

gene

ral p

ract

ice

Insu

fficie

nt s

uppo

rt fo

r GPs

Info

rmat

ion s

harin

g

Form

ing re

lation

ships

with

oth

er s

ecto

rs

Awaren

ess

of s

ervic

es

Differ

ence

s in

fund

ing

Differ

ence

s in

objec

tives

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Workloads and a lack of support for GPs to work in new ways were the largest barriers to achieving integrated care

To what extent to do you agree or disagree that these are challenges for achieving integrated care in your area?

N = 131 – 135

Protected time to participate in multi-disciplinary meetings and develop ideas would allow GPs to deliver more integrated care

Is there anything that would allow you to deliver more integrated care? (free text responses)

“More time to do this”

“Integrated IT systems instead of having to phone different departments to get a faxed copy of discharge summaries”

“Shared information between settings is vital!”

“Protected time away from seeing patients to help coordinate this…”

“More awareness of the patient’s needs and this means more time spent with the patient”

“Additional staff in general practice and the community”

Responses were grouped into themes. The size of the word denotes the frequency with which the theme was

mentioned

Reflections on the Whole Systems Integrated Care approach

A central aim of WSIC – to have ‘GPs at the centre of coordinating patient care’ – was interpreted in a variety of ways

How have you understood/interpreted the phrase ‘GPs should be at the centre of coordinating patient care’?

“GP is ‘coordinator’ not necessarily provider. Not necessarily job to arrange all items but should be central to knowing what is being provided to patient.”

“GP is key decision maker.”

“Common sense. We should look after our patients.”

“Increased workload without proper resourcing, taking away time from patient care... still lots of work in silos, lots of overlap.”

“I understand this as ‘when in doubt or can't be bothered to do anything for the patient, refer everything to the GP!!!’”

Less than half of respondents thought that integrated care has the potential to achieve WSIC’s goals

Quality

of c

are

will im

prov

e

GPs at

the

cent

re o

f org

anisi

ng c

are

Profe

ssion

al ex

perie

nce

will im

prov

e

People

repo

rt a

bette

r qua

lity o

f life

People

are

em

power

ed to

dire

ct th

eir c

are

Care

syst

em w

ill be

fina

ncial

ly su

stain

able

0%10%20%30%40%50%60%70%80%90%

100%

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Your local health and social care system is working on the basis that integrated care will produce a series of positive outcomes. We have listed some of these below (taken from the WSIC programme). To what extent to do you agree that integrated care has the potential to achieve the following outcomes?

N = 129 – 130

WSIC’s goals

The majority of respondents had heard about the WSIC programme, but one third reported being completely uninvolved

• Three quarters of respondents had heard about the WSIC programme;10% were not sure

• One quarter considered themselves to be very or quite involved in the design of the programme. One third of respondents had not been involved at all

• Nearly half said that they were involved in another integrated care initiative in their area – the most frequently mentioned were the Integrated Care Pilots in North West London, which many consider to be a precursor to the WSIC programme

Common perception of WSIC was that it was important but expensive and needed more focus on implementation

Do you have any comments about the WSIC programme? (free text responses)

“It is the best thing to happen over the last few years”

“It is a good thing”

“Delivery is now key and the challenging part”

“Very very very very complex”

“Translating it into practice will be difficult”

“An expensive waste of time”

“I agree with the principles but feel shared budget may not be the ideal way of doing it…”

Responses were grouped into themes. The size of the word denotes the frequency with which the theme was

mentioned

Conclusions

• GPs identified a need for more integrated care in North West London and felt that giving them more time and support to enable them work in new ways and improving the IT infrastructure would allow them to do this

• However, there was a lack of consensus about some of the core goals of the programme: namely, around the definition of GPs as the central care coordinators and whether integrated care could achieve this. There were also some concerns around the cost of the programme and the need to focus on implementation

• Less than half of GPs thought that integrated care could achieve WSIC’s goals, suggesting that GP buy-in could be difficult to gain

For more information about this slideshow or the evaluation, please contact Holly Holder,

Fellow in Health Policy, Nuffield Trust – 020 7631 8450; holly.holder@nuffieldtrust.org.uk

www.nuffieldtrust.org.uk

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