Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review

Abstract

Many national policies propose integration between primary and specialist care to improve the care of people with long-term conditions. There is an increasing need to understand how to practically implement such service redesign. This paper reviews the literature on the barriers to, and facilitators of, integrating primary and specialist healthcare for people with long-term conditions in the UK, with the aim of informing the development and implementation of similar initiatives in integration. MEDLINE and CINAHL databases were searched and 14 articles discussing factors hindering or enabling integration were identifi ed. The factors were extracted and synthesised and key lessons were tabulated. Successful integration of care requires synchronised changes on different levels, a well-resourced team, a welldefi ned and evidence-based service, agreed and articulated new roles and responsibilities, and a willingness among healthcare professionals to co-work and co-learn. Barriers to successful implementation of integrated care include a lack of commitment across organisations, limited resources, poorly functioning information technology (IT), poor coordination of fi nances and care pathways, confl icting objectives, and confl ict within teams. The examples of integrated working provide insights into problems and solutions around interorganisational and interprofessional working that will guide those planning integration in the future.

The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

“…In the process of changing clinical practice in health service delivery, the successes and failures are greatly determined by the people and processes either enabling or resisting the change [ 33 ]. Successful change requires new roles and responsibilities, and willingness among healthcare professionals to co-work and co-learn [ 34 , 35 ]. In Siun sote, the quality improvement of type 2 diabetes care has been active, and the quality of type 2 diabetes care at the primary-health care level has been shown to be very good [ 36 ], but there is always room for improvement.…”

Leadership for integrated care: a case study

“…While detail complexity refers to problems with many variables, a dynamic complexity refers to situations where cause and effect are subtle and uncertain with the same solutions having dramatically different effects in short vs long term and locally vs other locations (Senge, 1990). The process of integration may experience a variety of barriers since it asks different service providers to give up their independence to some degree, change the established ways of working, and balance conflicting expectations of their own organisations and the new integrated service (Kozlowska et al, 2018).…”

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

“…This makes the transition of patients across care venues a requirement that is buttressed on seamless coordination functions. Studies have highlighted that facilitating inter-organisational and interprofessional care planning for patients is capacitated by mechanisms such as a shared electronic medical record platform and joint clinical case conferences between providers at different care interfaces [ 30 , 31 ]. Harmonisation of cross level service delivery will enable both patients and providers to efficiently navigate within and beyond the province of primary care.…”