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 care

o 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 manager

Nurse

Administrator

16

3

1

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%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Older people struggleto find out what

services are available

Providers worktogether less

sucessfully thanneeded

Older people findaccessing services

confusing

GPs should be 'at thecentre of coordinating

patient care'

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

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 health

Comm: community

Hosp: hospital

AHPs: allied health professionals

LA: local authority

ASC: adult social care

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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quality of carewill improve

GPs at thecentre of

organising care

Professionalexperience will

improve

People report abetter quality of

life

People areempowered todirect their care

Care systemwill be

financiallysustainable

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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