Integrating primary care and social services for older adults with multimorbidity: policy implications

Over the next 20 years, the proportion of over-65s in the UK will rise by a quarter, 1 around two-thirds of whom will live with multimorbidity (multiple long-term conditions). 2 This change in demographic is likely to lead to a significant growth in care needs, 3 further increasing demand on primary care and social services. In response, policymakers have been trying to accelerate the drive towards integrated care 4 to deliver service efficiencies, cost savings and, concomitantly, improvements in outcomes for patients and service users. To this end, a variety of integrated care pilots have been trialled. 4 There have been concerns that some of these testbeds have been rolled out nationally without a strong evidence base or comprehensive evaluation, for example, ‘social prescribing’ initiatives. 5 This has led to uncertainty around the efficacy of integrated care initiatives, and no consensus on how best to integrate primary care and social services for older adults with multimorbidity. To address this gap in the evidence base, we carried out a mixed methods programme of research. This included a scoping review of the literature, 6 and a qualitative interview study to elicit key stakeholder views on drivers and barriers to integration of primary care and social services in England. Stakeholders included patients, care service users, carers, primary and secondary care clinicians, social prescribers, community nurses, social workers, voluntary sector workers, and multiple other relevant individuals. 7 We used Valentijn’s Rainbow Model of Integrated Care 8 as an analytical and spatial lens to interrogate and understand both the literature we identified and the empirical data derived from the semi-structured interviews. This conceptual framework describes integration occurring at and across a range of scales: the whole system level (macro-level integration); the organisational and professional level (meso-level); and the level of clinical and service integration (micro-level). In this article, we summarise our key findings and propose policy learning points.