Integrated care in practice: lessons from three tiers of healthcare provider and commissioner staff in two London Integrated Care Systems
Tracy, Derek K Lloyd, Lisa C Shergill, Sukhwinder S Hanson, Kara
Tracy, Derek K
Lloyd, Lisa C
Shergill, Sukhwinder S
Hanson, Kara
Affiliation
South London NHS Foundation Trust; King's College London; Brunel Medical School, London; Coventry and Warwickshire Partnership NHS Trust; Kent and Medway Medical School, Canterbury; London School of Hygiene and Tropical Medicine
Other Contributors
Publication date
2025-09
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Background: To better meet the growing demand and complexity of clinical need, there is a broad international trend towards greater integration of various elements of health- and social care. However, there has been a lack of research aimed at understanding how healthcare providers have experienced these changes, including facilitators and inhibitors of integration.
Aims: This study set out to generate new understandings of this from three UK staffing 'levels': 'micro' frontline workers, a 'meso' level of those leading a healthcare organisation and a 'macro' level of commissioners.
Method: Using Rogers' Diffusion of Innovation framework, qualitative analysis of individual interviews from provider staff perceptions was undertaken at these three levels (total N = 33) in London.
Results: English legislation and policy captured the need for change, but fail to describe problems or concerns of staff. There is little guidance that might facilitate learning. Staff identity, effective leadership and culture were considered critical in implementing effective integration, yet are often forgotten or ignored, compounded by an overall lack of organisational communication and learning. Cultural gains from integration with social care have largely been overlooked, but show promising opportunities in enhancing care delivery and experience.
Conclusions: Findings are mixed insofar as staff generally support the drivers for greater integration, but their concerns, and means for measuring change, have largely been ignored, limiting learning and optimisation of implementation. There is a need to emphasise the importance of culture and leadership in integrated care, and the benefits from closer working with social care.
Citation
Tracy DK, Lloyd LC, Shergill SS, Hanson K. Integrated care in practice: lessons from three tiers of healthcare provider and commissioner staff in two London Integrated Care Systems. BJPsych Open. 2025 Sep 15;11(5):e214. doi: 10.1192/bjo.2025.10841. PMID: 40947827; PMCID: PMC12451555.
Type
Article