Integrated care is the talk of health and social care services but can the current and future health professionals really deliver it? Saira Ghafur and Angelika Zarkali delve deeper
The NHS is currently under unprecedented demand with extreme pressures on emergency services and primary care. The NHS Five Year Forward View outlines the need for change and innovation in the way we provide care.
There is a need to move away from silo working and focus on integrating care and prevention throughout the whole health system.
‘Most specialty training for hospital doctors does not currently encompass community based training’
To accomplish this, new models of care have been proposed in the form of multispecialty community providers (or MCPs) and primary and acute care systems (or PACS), which have been welcomed by GPs, clinical commissioning group leads and providers in a recent HSJ/FTI Consulting survey.
A burning question is who will staff this service, especially given the recruitment difficulties being faced by general practice?
At the same time, GPs are reporting rising levels of stress and burnout, with an increasing workload.
Where does this leave us for the future? Specialty training for hospital doctors does not currently encompass community based training except for a few specialties such as older people’s care, diabetes and paediatrics.
These issues need to be addressed to ensure the models of care proposed can truly provide form and function with an adequately trained workforce.
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Theory versus practice
To improve our understanding of this issue, we surveyed 428 trainee doctors who will in future provide the workforce for these new models of care. In total, 242 GP trainees and 186 trainees in various medical specialties and paediatrics gave their views on, and experiences of, integrated care.
The majority of respondents (76 per cent of doctors and 77 per cent of GP trainees) were in favour of integrated care and reported that primary and secondary care should work closer together to improve patient care.
Trainees expressed a need for better communication to provide a more comprehensive approach in providing patient care.
However, it was felt that greater integration would result in:
- reduced waiting times;
- avoidance of unnecessary admissions; and
- improved patient experience.
Despite this, only a minority of trainees have had any experience of working in an integrated way, with only 32 per cent of physicians having any training sessions in the community and 24 per cent of GP trainees having experienced integrated care during their training.
Respondents reported that although GP trainees spend up to half of their training in a secondary care setting, trainee physicians often do not receive any training in the community unless they have had a GP placement at foundation level.
Both GP (72 per cent) and physician trainees (72 per cent) agreed that training will need to change to enable the provision of integrated care at the level expected.
With limited exposure to providing care in a community based setting during postgraduate training, trainees expressed concern over the ability to deliver this.
Lack of exposure to primary care for trainee physicians also leads to poor communication with GP colleagues and a lack of understanding of the challenges of working in the community.
‘Trainees did not have a clear vision of how integrated care would be realised’
Training in community settings would be beneficial to fully appreciate the services available, their limitations and their advantages.
Despite being very supportive of integrated care in principle, the survey showed that trainees did not have a clear vision of how this would be realised, and often had different understanding of what integration would mean in practice.
Both GP and physician trainees were sceptical about the feasibility of integrated care models in the current NHS and the most commonly voiced concern was the lack of postgraduate training in integrated settings.
Change must come
Trainees felt that postgraduate education has to change to incorporate more training opportunities in collaborative, community based settings for these new models of care to become a reality.
The new models of integrated care outlined in the forward view are a great challenge and a great opportunity. With the increasing complexity of healthcare, these models aim to address improved integration, resulting in better outcomes and experience for patients.
‘New models of care are a great challenge and opportunity’
There is wide support for these changes in the NHS and our survey suggests that trainees want integrated care and collaborative working to ensure better patient care. However, this will require more GP trainees and more postgraduate training being provided in the community setting.
To ensure these models are not compromised, it is crucial that the new services are accompanied by a cohort of health professionals who have been suitably trained to deliver optimal patient care.
Dr Saira Ghafur is a national medical director’s fellow at NHS England and specialist trainee in respiratory and general internal medicine; and Dr Angelika Zarkali is national medical director’s clinical fellow at NHS England and core medical trainee. Assistance in the writing of this piece was provided by Dr MIke Bewick, deputy medical director of NHS England.