From collaboration to commissioning: developing relationships between primary health and social services.

Since the publication in 1989 of the white paper, Caring for People, the benefits of collaboration between primary health and social services have been emphasised—albeit with little guidance on how to achieve this. 2 The success of emergency initiatives to reduce pressure on hospital beds and, in future, health action zones, will also depend on good relationships between agencies. The recent NHS white paper also emphasises the importance of partnerships, and proposes that local authority representatives are involved in both primary care groups and health authority meetings. Collaboration is important, particularly since the 1993 changes in community care, because general practitioners and social services staff act as gatekeepers to other services. General practitioners control access to secondary and community health services through patient referrals. Social services departments manage funding for home care services and residential and nursing home places and control access through assessment and care management. When one professional or organisation depends on another professional or organisation to obtain services, their ability to achieve their own professional or organisational objectives is affected crucially. Thus, general practitioners depend on social services’ funding of nursing home places or intensive domiciliary services to avoid admission to hospital for some patients or to support other patients after discharge home. For many general practitioners, closer links with their social services department are a high priority. Some writers have argued that the surgery is an ideal base for social services because of the universality that characterises primary care. Others have suggested that general practitioners should be given an integrated budget from which they can purchase both health and social services. Although some studies have indicated a lack of success in achieving collaborative working, this may reflect a lack of clarity and realism about the goals and barriers associated with joint working. 8 We describe several initiatives designed to improve collaboration between primary health and social services. We have drawn on two data sources. Firstly, we searched databases such as BIDS, HELMIS, CAREDATA, and DHS-DATA and professional journals for publications about collaboration between primary health and social services (excluding initiatives focusing only on children’s services) since 1990. Secondly, we investigated a number of joint primary health/social services initiatives through site visits, interviews with key stakeholders, and scrutiny of project documents.