Crossing the tracks: continuing inter-professional development in social and primary care

Abstract

Introduction: The need to positively engage professionals in the development and practice of integrated care is well researched. Constructive professional difference is an enabler of holistic care and support, but inter-professional rivalries, misconceptions and mistrust can undermine integration. Inter-professional learning and development is seen as one option to facilitate better joint working between professions. This case study presents the development of a resource to support such development across the crucial boundary between adult social care teams and general practice in the UK. Change in practice: Following theories and insights from previous research regarding inter-professional learning, the resource was created followed the stages below: Review of evidence: A literature review of evidence regarding general practice – social work interaction was completed to identify previous research regarding inter-professional experience and practice in this area and attempts to address any issues through learning and development. Gaining perspectives: Focus groups were carried out separately with general practices and with adult social work teams. These sought to gain the views of the range of professions and practitioners within the two services regarding their knowledge of those working in the other services and their experience of collaborating. Groups were then asked to reflect on the strength of their own profession and their ability to work collaboratively. Finally different options regarding inter-professional development were presented for their comment. From these discussions it became clear that services would typically only be able to allocate up to 4 hours for such sessions and that the professionals would prefer interactive face-to-face sessions. Developing resources: The resources were developed by a multi-professional team which included those from a nursing and social work background. Involving professionals and practitioners from both services, the sessions would be facilitated by someone external to the services and be structured around the following themes: Sharing impressions: Participants are asked to identify which services made a quote regarding professions in one of the services and their ability to collaborate. This is carried out within mixed groups and was used to generate discussion of the thinking that lay behind the quotes and their selection of the stakeholder concerned. Sharing knowledge: Participants are separated into single service groups and asked to respond to a series of questions regarding key aspects of the professions within the other service – how are they trained, governed, incentivised etc. They then match with a group from the other service and share their answers, with the service in question clarifying and correcting their knowledge. Sharing roles, values & conflict: Participants return to mixed groups and follow a three stage case study. The case study and related questions provide a focus for exploration of respective contributions to supporting someone with complex health and social care needs, the values that underpin their work, and how they would (or would not) deal with conflict Sharing plans: personal and collective action planning is facilitated in response to what they have learnt and reflected upon during the session. Delivering the sessions: the initial sessions were facilitated by the team which developed the resources. Feedback was provided at the end of the session by participants and this was then followed up with a short on-line survey to explore further their learning and potential behavioural change. The facilitators met to discuss feedback and iteratively develop and refine the materials. Key findings: Despite considerable contact with professionals from the other service over several years (if not decades) knowledge of, and confidence in, working with others was often weak. The principles of inter-professional learning can be applied successfully to short continuing education sessions. A multi-professional development and facilitation team provides the knowledge and insights to engage successfully with an inter-professional group Highlights of learning: The process of reviewing evidence, gaining perspectives of a sample of the key professionals, and developing sessions on these experiences worked well. The current and ‘real’ experiences and views provided validity to the content. Considerable difficulties were encountered in the recruitment of services to participate due to other priorities, changing structures and a lack of recognition of the cultural aspects of joint working alongside those of systems and processes Conclusion: Despite the importance of inter-professional issues many professionals and their organisations struggle to prioritise it as an area for improvement alongside more technical and process challenges. However with careful planning and thoughtful facilitation even a short inter-professional session can help to break down barriers and provide a foundation for better joint working in future.