Interprofessional working in primary care: Barriers and Levers to Implementation. A qualitative analysis of the views of primary care professionals

Problem

Internationally, primary care is the cornerstone of healthcare planning and reform with a consistent emphasis on the scope for primary care interdisciplinary team working to improve patient experiences and the effectiveness of care. Despite policy imperatives, full implementation of interdisciplinary team working has been slow across a number of developed countries, including Ireland. This represents an important problem of translational research. However, there is a lack of comprehensive, theoretically informed research exploring levers and barriers to implementation of these policies. The aim of this study is to explore primary care professional’s (PCP) perceptions of levers and barriers to implementation of policies for interprofessional Primary Care Teams (PCTs) in Ireland.

Approach

Method: This is a qualitative case study using Normalisation Process Theory (NPT). We employed maximum variation sampling to identify three case study sites with different histories and configurations (in terms of governance, resources and staffing models) of interdisciplinary team working. Two trained researchers in qualitative methods conducted semi-structured interviews with PCPs at these sites, interviews were transcribed and thematically analysed using Framework analysis. Data generation and analysis were informed by NPT.

Findings

Results: Thirty-three interviews were conducted with eight GPs and 25 other PCPs. Twenty-five were working on a statutory Health Service Executive (HSE) PCT and eight were working on a GP initiated team comprised entirely of private PCPs. Overall, all PCPs were positive about the idea and potential value of interdisciplinary team working and considered that it was legitimate for them to be involved in this way of working.

While PCPs at two sites engaged with the HSE PCT model, PCPs at the third site could not make sense of the proposed model and never engaged with it. PCPs at all sites emphasised the benefits of having a dedicated driver to keep the team going, being co-located and having good working relationships based on trust and confidence in each other’s work.

PCPs in the two HSE PCTs had better systems in place for formal meetings than the other team whose interactions were more adhoc and informal. However, PCPs in the HSE PCTs described challenges with their formal meetings including lack of administrative support and diminishing resources during the recession. They also reported examples of interdisciplinary work that occurred informally, which was not captured by any HSE metrics and was sometimes considered more valuable than the formal meetings.

All PCPs generally appraised their work, in terms of patient benefits, in positive terms.

Consequences

Conclusion: There is a significant amount of interdisciplinary working in the Irish setting but only some of this is captured by formal HSE metrics. Further research should focus on patients’ perspectives and the sustainability of these different forms of interprofessional team working to guide further policy development.