Front-line perspectives on ‘joined-up’ working relationships: a qualitative study of social prescribing in the west of Scotland

Abstract

Cross-sector collaboration has been promoted by government policies in the United Kingdom and many western welfare states for decades. Literature on joint working has focused predominantly on the strategic level, neglecting the role of individual practitioners in putting 'joined-up working' into practice. This paper takes the case of 'social prescribing' in the west of Scotland as an instance of joined-up working, in which primary healthcare professionals are encouraged to refer patients to non-medical sources of support in the third sector. This study draws on social capital theory to analyse the quality of the relationships between primary healthcare professionals and third sector practitioners. Eighteen health professionals and 15 representatives of third sector organisations participated in a qualitative interview study. Significant barriers to collaborative working were evident. The two stakeholder groups expressed different understandings of health, with few primary healthcare professionals considering non-medical sources of support to be useful or relevant. Health professionals were mistrustful of unknown third sector organisations, and concerned about their accountability for referrals that were not successful or positive for the patient. Third sector practitioners sought to build trust through face-to-face interactions with health professionals. However, primary healthcare professionals and third sector practitioners were not connected in effective networks. We highlight the ongoing imbalance of power between primary healthcare professionals and third sector organisations. Strategic collaborations should be complemented by efforts to build shared understandings, trust and connections between the diverse front-line workers whose mutual co-operation is necessary to achieve effective joined-up working.

Factors affecting general practice collaboration with voluntary and community sector organisations

“…First, GPs and VCS organisations are likely to have opposing norms and values with regard to the causes of, and solution to, the healthcare needs of communities, which need to be reconciled for GP‐VCS collaborations to develop (Aveling & Jovchelovitch, ; White et al., ). This conflict of medical and social models reflects Bryson et al.…”

“…An understanding of the role of individual actors in the delivery of an intervention (White et al, 2010) is perhaps a minimum of what is needed for GPs and VCS organisations to work together. For collaboration to become more "holistic" and "embedded", a shared set of beliefs and values is required (White et al, 2017;Whitelaw et al, 2016). While primary care may be resistant to change (Morténius, Fridlund, Marklund, Palm, & Baigi, 2012;Ross & Kettles, 2012), a strong evidence base (Bungay & Clift, 2010) and being built around a clear local need may support a shared understanding and trust between organisations.…”

“…While primary care may be resistant to change (Morténius, Fridlund, Marklund, Palm, & Baigi, 2012;Ross & Kettles, 2012), a strong evidence base (Bungay & Clift, 2010) and being built around a clear local need may support a shared understanding and trust between organisations. Personal relationships between staff members across organisations are the foundation of collaborations (White et al, 2010(White et al, , 2017 and opportunities for meaningful formal and informal communication are needed to support the development of relationships. Both GPs and VCS organisations need to be sufficiently resourced to devote time and effort to collaborative working (Goldberg et al, 2013;South et al, 2008).…”

“…The most widely understood and promoted conceptualisation of GP-VCS collaboration is "social prescribing", in which a GP and VCS organisation partner together, so that patients are linked with sources of non-clinical support in their community through a "referral" from a clinician (South, Higgins, Woodall, & White, 2008;White, Cornish, & Kerr, 2017). The term brings together an assortment of activities and service delivery models (White et al, 2017), including arts (Bungay & Clift, 2010) or exercise (Pedersen, Helmer-Nielsen, Dieperink, & Østergaard, 2016) on prescription. Some social prescribing models have patients referred directly from a GP to a VCS organisation.…”

“…Cited effective factors to GP-VCS collaboration include understanding of roles (White, Kinsella, & South, 2010), organisational capacity (Goldberg, Mick, Kuzel, Feng, & Love, 2013;South et al, 2008), awareness of partners capabilities (Grant et al, 2000), operational procedures (White et al, 2017), trust (Brandling & House, 2007;Mossabir et al, 2015), organisational (in) stability (Brandling & House, 2007), evidence base (Bungay & Clift, 2010), status and power (White et al, 2017), policy and legislative context (Bungay & Clift, 2010;Whitelaw et al, 2016), staff skills (Mossabir et al, 2015;South et al, 2008;Woodall & South, 2005), physical proximity (Mossabir et al, 2015;Woodall & South, 2005), interpersonal relationships (White et al, 2010(White et al, , 2017 and leadership (Mossabir et al, 2015;Whitelaw et al, 2016). Of particular importance is reconciling the conflicting medical and social models between GPs and VCS organisations (Aveling & Jovchelovitch, 2014;Popay, Kowarzik, Mallinson, Mackian, & Barker, 2007;White et al, 2017;Whitelaw et al, 2016). Collectively, these factors are thought to form a critical mass for sustainability (Whitelaw et al, 2016).…”