It is a measure of the speed with which primary care is changing that this account of relationships between social services and primary care already reads like history. It is not that the authors delve deep into the annals of social policy.On the contrary, much of their analysis focuses on developments that took place in the mid to late 1990s, when experiments in joint commissioning between primary and social care organisations took place.
Experiences gained in these early partnerships, together with those acquired through more long-established joint working on the front line between GPs, social workers and community nurses, are reviewed for evidence of what is known to have worked well or failed. While there is a commendable attempt to make sense of different approaches adopted in commissioning and providing services for older people, the evidence predates the advent of primary care groups and primary care trusts.
Does this matter? Not as far as the authors are concerned. They clearly believe that people involved in present-day partnerships can learn a great deal from these early experiences.
They hope their book will 'assist health and social care organisations and professionals to develop new ways of working together, in order to deliver more effective and efficient services to older people with complex needs'. Certainly, the models they examine are relevant to current developments in primary health and social care, encompassing early efforts to create quasi-single commissioning agencies, integrated primary health and social work teams, practice-based care management and social work attachments to general practice.
Furthermore, many of the difficulties encountered then continue today, including problems around boundary coterminosity, continuing organisational change and professional isolation. Drawing on these early experiences, the authors summarise the lessons that have emerged, highlighting success factors and barriers to collaboration.
What is clear is that all kinds of dangers lie ahead, and the errors of the past could well be repeated. Most of the primary care players come with little knowledge of social care and little experience of joint working.
However, primary care partnerships have the advantage of new opportunities, such as those offered by the Health Act flexibilities and the availability of partnership and prevention grants.
These new incentives lead the authors to be upbeat about the prospects for future partnerships. They make no suggestion that it is time to give up onpartnership by, for instance, enabling PCTs to take over responsibility for commissioning social care for older people. Indeed, they indicate that few would be ready to take on that task, given evidence about the state of readiness among primary care practitioners to embark upon strategic commissioning and service development.
As it reflects on the past and speculates on the future, this book should assist those who are facing a steep learning curve. At times, the lessons learned about successful partnerships sound like pretty basic stuff, especially where it is pointed out that joint schemes need to be carefully planned and that commitment from both sides is needed.
This may be a turn-off for partnership enthusiasts who are already steaming ahead with ambitious plans for the future. At the same time, this approach may be valued by the more cautious, who are still feeling their way.
Perhaps the basic ingredients of successful partnership still need to be spelt out for newcomers to joint working. If so, this shows how far we have to go to make primary care partnerships work.