P171 'It's a great idea, but I didn't really see how it was integrated': a qualitative interview study to understand the collaboration between secondary care, community care and commissioners to deliver an integrated respiratory service. (12th November 2019) - Stone, TJ
Abstract : Introduction and objectives: Integrated care systems are central to the NHS 10 year plan. Commissioning to achieve integration of primary and secondary care services for respiratory conditions is taking place amongst an increasing number of clinical commissioning groups (CCGs). However, the relationship between service design and delivery at the point of staff experience is not well understood. The King's Fund suggested that embedding integrated care might be 'a bumpy ride'. This study sought to explore the dynamics of the implementation process. Methods: Nineteen in depth qualitative interviews were conducted with commissioners, hospital clinicians/managers and community provider clinicians/managers. Interviews were audio-recorded, transcribed, imported into NVivo11 and analysed using inductive thematic analysis. Results: Interviewees provided a variety of perspectives on a newly launched Integrated Respiratory Service, highlighting and explaining the barriers and successes from their differing positions in the process. The interviews identified that: 1. There was support for the principle of integrated care as a 'good idea' but widespread recognition that integration had not been fully realised; 2. Successful integration depended on trust and communication but cultural, structural and resource factors proved to be significant barriers; 3. Specific areas of tension arose around clinical governance, patient 'sharing', communication 'styles', and perceptions of the rationale of integration. Conclusions: This study offers insight from direct experience and a range of perspectives on the development and implementation of a newly designed integrated respiratory service. The greatest opportunity to expediate better communication, trust and subsequent integration should be at the commissioning stage. Commissioners having a clear understanding of current provision of services and encouraging input from stakeholders at all levels at the development stage may prevent later difficulties. The study offers directly transferable knowledge pertinent to the embedding of integrated healthcare services generally in line with current NHS priorities of reducing pressure in the secondary care settings.