Whole system working: the interface in Scotland

11 December 2020 

This week, I wanted to share a blog from Dr David Shackles, Joint-Chair Elect of RCGP Scotland, Dr Patricia Moultrie, Deputy Chair of BMA SGPC and Dr Miles Mack, Chair of the Scottish Academy of Medical Royal Colleges and Faculties.

The blog highlights the fantastic work that has been undertaken by both RCGP Scotland and BMA Scotland on promoting and delivering effective interface working across and within health and social care.

Of course, effective interface working requires a whole system approach and we are therefore extremely grateful to the Scottish Academy of Medical Royal Colleges and Faculties for endorsing this paper.

Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Effective interface working has never been more important 

Working effectively across traditional boundaries in medicine has never been more important than now in this period of rapid change with both the challenges and opportunities that COVID-19 and new ways of working that presents.

This will continue to be the case as we collectively support patients with the longer-term health impacts of COVID-19.

Yet a long standing and hugely important issue in medicine remains how we work together between different parts of the healthcare system - or more technically, the interface at which two separate entities within our overarching NHS come together.

This interface can be between:

  • primary and secondary care
  • in-hours, and out of hours care
  • health, and social care, or within primary care itself across the multiple interfaces of extended multidisciplinary teams.

These systems are independently complex and do not always relate or communicate well with each other.

Different parts of healthcare have their own cultures, priorities and terminology and lack of specific measures to address this can create problems which impact on patients.

Whole system working

That is why working together the BMA, RCGP Scotland and the Academy of Royal Medical Colleges and Faculties in Scotland have produced a new paper aimed at addressing the problems that can occur at interfaces, setting down principles for interface and joint working which we believe can help improve working across boundaries - or in other words, across the whole system.

The Whole System Working: The Interface in Scotland (579 KB PDF) paper is based upon the key proposition that improvements can be delivered - in particular across the secondary and primary care interface - by understanding roles and responsibilities, developing high trust relationships, having the right people in the room and adhering to agreed principles.

The paper articulates 6 key principles for joint working based on the following areas:

  1. Patients: A clear focus on the patient journey and the individual at the heart of the care provided.
  2. Information: Effective sharing of information and IT systems that facilitate this across systems, in particular reducing the risk of gaps and lack of access to relevant data.
  3. Quality of care: Effective review of quality of care from all sources - including patient feedback.
  4. Learning: Shared learning and training opportunities - staff can only work effectively together if they understand each other’s situation and priorities.
  5. Staff attitudes: Mutual respect between clinicians working in different roles and in different areas of practice, whether community care, primary care, or secondary care.
  6. Staff engagement: Clinicians must be supported to identify and address issues which occur at interfaces of care, and there must be mechanisms in place to enable resolution of issues.

There are more details on exactly what these principles mean, and how they should be interpreted in the publication.

But at the core of this is helping to facilitate better interface working and the key steps that will help make that happen - along with mitigating the risks that poor interface working poses to safe and effective care.

The remainder of the paper focuses on the key characteristics which constitute an effective Primary-Secondary Care Interface Group at NHS board level.

It is our firm belief that if properly constituted and effectively resourced, these groups can make a real difference and improve interface working in their local areas.

We propose that all boards should have such Primary Secondary Interface Groups and these groups should be clearly signposted to both Primary and Secondary care clinicians and managers.

Of course, this is a longstanding and complex issue - but we do believe that substantial improvements can be made and that this paper provides a blueprint on exactly how that might happen..

Post written by

Dr David Shackles, Joint-Chair Elect of RCGP Scotland, Dr Patricia Moultrie, Deputy Chair of BMA SGPC and Dr Miles Mack, Chair of the Scottish Academy of Medical Royal Colleges and Faculties

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