Facilitating partnership working in public health: evaluation of a clinical service development approach

Abstract

BackgroundUK health policy identifies partnership working as fundamental to tackling health inequalities. Related to this is the development of a multi-disciplinary public health workforce, including an increase in the public health role of primary care nurses. Within this policy context, a primary care trust in the north of England established a community health team (CHT) in September 2005 to improve intra- and inter-agency working for public health. The Clinical Microsystems (CMS) framework informed the process of development, an approach not previously applied to public health.AimThis paper describes an evaluation of the CHT and presents the key lessons learnt in terms of what worked and did not work in the context of the CMS framework.MethodsParticipants were members and wider stakeholders of the CHT from three professional groups: individuals holding relevant strategic posts in the Public Health and Nursing Directorates within the Primary Care Trust, health visitors and school nurses, and voluntary sector staff. Focus group (n = 9 focus groups) and postal questionnaire (n = 21) data were collected at baseline, 6 and 12 months post-implementation. Participants’ views on the implementation of the CHT were explored within the ‘five Ps’ (purpose, population, people, processes and patterns) of the CMS framework.FindingsSix themes emerged from the focus group data that illustrated key issues for the implementation of the CHT: ‘agreeing the focus,’ ‘strong leadership,’ ‘the challenge of communication,’ ‘managing workloads and new ways of working,’ ‘success of the CHT’ and ‘outside influences.’ Communication and heavy workloads were identified as key barriers to the success of the CHT in the questionnaire data. These data highlight the complex and evolving nature of public health partnership working and identify important issues that might usefully be considered in future initiatives of this kind.