Health care is increasingly under pressure. Budget crises are making collaboration and smart thinking essential, while increasing numbers of people with multiple long-term conditions make specialist models of health care increasingly inefficient – patients too often go from one specialist to another, duplicating effort and paying too little attention to the bigger picture of their health.
Collaborating for Health outlines a solution: community-oriented integrated care and health promotion. Designed to prevent the problems of fragmented care, this approach focuses on building teams, networks and communities for health and care at local level, where it is easier to see the range of factors that affect people’s health. With the emphasis on partnership-working between primary care, public health and others, it allows clusters of general practices to share the work of integrating efforts for care and health improvement, and for non-medical organisations to lead parallel initiatives for health and care. Introducing both horizontal and vertical integration, Thomas presents ways to develop community-oriented integrated care in a sustainable way, and how to practise the skills in small ways before you have to perform on a big stage.
This guide is for anyone interested in how multidisciplinary primary care teams can orchestrate most aspects of health and care at local level, with timely specialist input.
Table of Contents
Section A. Policy to support integrated working Chapter 1. Communities for Health Chapter 2. Shared care for long-term conditions Chapter 3. Seasons of learning and change Chapter 4. Infrastructure of facilitation and communication Section B. Integrating care & promoting health from local organisations Chapter 5. Annual cycles of participatory action research Chapter 6. Live manuals Chapter 7. How to see connections between parts and wholes Chapter 8. How to run meetings that make sense of multiple perspectives Section C. Integrating care & promoting health from geographic localities Chapter 9. Engaging people in cycles of inter-organisational learning and change Chapter 10. Large group events help people to creatively interact Chapter 11. Structured Inquiry – an important ingredient Chapter 12. Maintain inner peace Section D. Understanding community-oriented integrated care Chapter 13. The story of community-oriented integrated care Chapter 14. General practitioners are sense-makers Chapter 15. Health, identity and relationships Chapter 16. Three paradigms of inquiry illuminate evolving stories Section E. Community-oriented integrated care – making it work Chapter 17. Networks for complicated journeys Chapter 18. Developing team players and systems thinkers Chapter 19. Learning organisations build teams and communities Chapter 20. Public health and primary care – an essential partnership Appendix: Skills to lead community-oriented integrated care
Paul Thomas is a general practitioner in west London, professor of primary care research, education and development at the University of West London, UK, and honorary senior lecturer at Imperial College, UK. He is editor-in-chief of the London Journal of Primary Care, an international, Pubmed-cited journal that publishes case studies of integrated working in primary care and local communities.
'This is a powerful book and an important contribution to the literature on integrated care. Its timing is impeccable, coming as it does with the publication of the NHS Sustainability and Transformation Plans (STPs) which are aimed at creating accountable care systems for integrated care and in which system leadership is critical – the raison d’etre for this book in my view. As someone closely involved in STPs, I have found this book immensely helpful. It is essential reading for anyone involved in STPs, particularly in creating primary and community integrated care services at scale. As a minimum, Thomas’ three tier model of long-term conditions management is a winner and should be adopted widely and quickly to improve outcomes and deliver better value. The book not only provides the evidence base for change but also practical support, for example "live manuals" and comprehensive skills checklists. I like the suggestions of ‘seasons of learning and change’ and his model of connectedness (as the link, glue and cell) is memorable. To cap it all the book is littered with enjoyable references to the arts and literature with quotes from Shakespeare, Kipling and others.' – Professor Mayur Lakhani, CBE; RCGP President and GP; Chair of West Leicestershire Clinical Commissioning Group; past Chair of the Royal College of GPs and The National Council for Palliative Care
'This is an interesting, important and relevant book that will be a valuable resource for all leaders and change agents trying to change, improve and integrate primary care services and to do so in a system based way. It obviously addresses a key health policy agenda. The text combines expositions of useful organizational concepts, mini cases, practical exercises, references to further sources and visualisations in an attractive and accessible mix. It should be a key reference point for all those seeking to promote community orientated and more integrated primary care.' – Professor Ewan Ferlie, King’s College London, UK
'This book and its author, Paul Thomas, are conceptual, practical and wise guides to the health care organizational change we all want. Using stories that make sense and ideas that challenge we are led on both revolutionary flights of inspiring imagination and into grounded lived experiences. The book convinces us that healthy systems are possible and necessary in these challenging times. Paul himself, his journal and inspiring colleagues have been guides for me as I struggle to integrate primary care and public health in community settings. The book is intergenerative as we reach between disciplines and professions to go beyond to a better, more healthy future.' – Professor Peter Whitehouse, Case Western Reserve University, USA and University of Toronto, Canada; Strategic Advisor in Innovation Baycrest Health Center; President, Intergenerational Schools International
'If you are looking for a definitive text that will afford both the supporting theory and the practical tools to make brilliant care happen for brilliant people then this is it. People live in communities; they thrive in communities and yet when we talk about health and social care systems we tend to make only paltry reference to the most critical of operating systems – the social economy of families and neighbourhoods. Within these neighbourhoods, co-existing alongside people in their homes, are our primary care colleagues. Has there ever been a better time to utilise and build on the strength and the continuity of relationships that primary care offers? Make great use of this book and draw on the wisdom that it reminds us that we hold. Let us organise our worlds differently and collaborate generously for better health for everyone.' – Siobhan Clarke, Managing Director of Your Healthcare CIC
'If, like me, you are frustrated that R&D usually focuses solely on research and you wish to focus on development – this book is for you (although in the spirit of this book they should be as one). If you value trusted relationships in shared care and collaborative health promotion at local, community level – this book is for you. If you wish to be guided by an experienced, highly intelligent and intellectual General Medical Practitioner who is an expert in facilitation and community development and yet, in my personal knowledge of him, does not "lose the common touch" – this author is for you.' – Professor David Colin-Thomé, Manchester Business School, UK, and GP; former National Clinical Director for Primary Care; Medical Adviser for Commissioning and System Reform
'The NHS is facing a massive challenge with increased demand, an ageing population and advances in science and technology. Primary care has always been the jewel in the crown of the NHS and its expansion and development is seen now by government and policy makers as the way to resolve the challenge. Analysis shows it need to expand its offering by a third as described in the NHS England "Five Year Forward View". We need to shift care into the community and support patients to manage their health and wellbeing. Social prescribing in general practice will be one of the key projects along with integrated care. Why is this important for patients? Just one example relates to end of life care, where typically 60% of patients die in hospital and yet nearly all would prefer to die at home surrounded by their loved ones. Supporting patients at home would be a far more compassionate service for patients, deliver great primary care and deliver much better value for money. This book shows us how we can deliver this change with practical examples. It is essential reading for anyone passionate about primary care and the NHS.' – Professor Sir Sam Everington, OBE; GP and Barrister
'In the Western world the traditional model of primary care is broken. The foundations for our health services, of demand being curtailed by cure was false. Communities and services need to forge new relationships that are more about "co" than about expert and recipient, to support people to better health and to better use our health service resources. Bringing the talent, insight, research of health service professionals, together with the assets of communities in a collaboration will take a real focus on relationships, and on being adaptable together. This book charts the complex change required from the list-based GP to a population-based health model. It provides a wealth of tools for inquiry and change that support the transition. Start anywhere in the book and go everywhere.' – Professor Rebecca Malby, London South Bank University, UK
'I was struck when I started this innovative book by how applicable it was to my field – education. It quickly became clear, though, that this is precisely the point that is so lucidly made: it is very apparent that we are all part of the same unfurling narrative: this study shows that it is not so much that it’s all about inter-connectivity – there is actually nothing but inter-connectivity. This has important implications for how we set about devising and delivering the school curriculum.' – Paul Stubbings, Headmaster of Cardinal Vaughan Memorial School, UK
'Paul is and has always been a passionate advocate for innovation and quality improvement in primary care. A decade and a half ago he was articulating coherently his vision of health care [primary, community and secondary], mental health care and social care professionals working closely and focusing on the delivery of care on populations of 100,000 patients; he referred to this as Local Health Communities. The aspiration was an integrated patient-centred care model with a clear focus on improved communication and team working. This was a very avant garde concept at the time but is now the basis on the NAPC Primary Care Home model and the Multi speciality Care Provider model described in the NHS Five Year Forward View. The fact that the Local Health Community vision is now being realised is a testament to Paul's radical ideas being understood and implemented many years later.' – Professor Raj Chandok, Buckinghamshire New University, UK and GP; Vice Chair, NHS Ealing Clinical Commissioning Group
'Thought-provoking! An enjoyable read for professionals through to commissioners and policy makers. Thomas’s book is a major contribution to healthcare and inspires transformational change, especially for care for people with Advanced Serious Illness and End of Life needs. Perfect for GPs and clinicians in primary care, the book provides insight and practical advice on a community-oriented integrated care approach. Using interesting case studies, evidence and reflection exercises throughout, it manages to bring to life strategies and drivers, not merely for the treatment of diseases but to enable local society collaboration for whole population health. Thomas illuminates how dynamic inquiry can be used to enable real-time strategic change. Crucially, the book engages how learning communities can embrace openness in order for learning and change to be the cultural norm. Leaders will not regret experiencing their own adventure when reading his methods to balance their own inner peace when confidence or control of their vision is threatened! In summary, a glorious banquet to feast your eyes and open your minds.' – Catherine Millington-Sanders, RCGP/Marie Curie National Clinical End of Life Care Champion