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Frontline barriers to integrating primary and social care

A qualitative study exploring frontline perspectives on barriers to integration between primary care and social care in England.

Key messages

  • frontline staff identified three main areas where barriers to integration persist: access to social services, interprofessional relationships and infrastructure
  • difficulties contacting staff across sectors create delays in referrals and care coordination
  • hostile working cultures and siloed practices contribute to poor collaboration between primary and social care
  • overworked staff, inefficient multidisciplinary meetings and unclear responsibilities slow responses to patient needs
  • lack of interoperable information systems, absence of pooled budgets and misaligned managerial incentives compound structural barriers.

Policy implications

  • improving integration may require investment in interoperable information systems across sectors
  • pooled budgets and aligned incentives could reduce structural divisions between primary and social care
  • workforce strategies should address interprofessional relationships and organisational culture, not only processes
  • clearer accountability arrangements may help reduce diffusion of responsibility in integrated working.

Gaps

  • findings are based on London GP surgeries and may not reflect experiences in other regions
  • perspectives of social care staff are not included
  • limited insight into how barriers change over time or respond to policy interventions.

Commentary
This study highlights how workforce experiences shape the effectiveness of integration between primary and social care. Barriers are not limited to systems and structures, but are deeply influenced by relationships, culture and everyday working practices.

Difficulties in accessing social services and contacting staff across organisational boundaries delay referrals and disrupt continuity of care. From a care equity perspective, these delays may disproportionately affect people with complex needs who rely on coordinated support across sectors.

The findings also point to cultural and relational barriers. Hostile interprofessional relationships and siloed working undermine collaboration, while overwork and inefficient multidisciplinary meetings limit the capacity of staff to engage meaningfully in integrated care.

Structural issues, including non-interoperable information systems, lack of pooled budgets and misaligned incentives, further strengthen division between sectors. These barriers suggest that integration efforts focused solely on frontline practice are unlikely to succeed without also undertaking system-level reform.

Overall, the study shows that achieving equitable, integrated care requires attention to workforce conditions, organisational culture and infrastructure alongside policy and funding mechanisms. Without addressing these interconnected barriers, integration risks remaining aspirational rather than embedded in routine practice.

Workforce lessons from neighbourhood integration

Programme learning on how local areas have addressed workforce challenges in delivering integrated care at neighbourhood level.

Key messages

  • successful neighbourhood integration relies on strong cross-sector relationships and shared leadership
  • co-located teams help reduce workforce fragmentation and improve coordination
  • joint governance arrangements, including shared decision-making and pooled budgets, enable more responsive services
  • shared working practices based on trust, co-production and common protocols support consistent, person-centred care
  • learning draws on case studies from Haringey and Islington, Leeds, Luton and Norfolk.

Policy implications

  • neighbourhood integration requires investment in relationship-building as well as structural change
  • governance models that support joint accountability may improve pace and flexibility of delivery
  • workforce strategies should support co-location and shared practice across organisational boundaries
  • long-term investment is needed to sustain neighbourhood-level integration.

Gaps

  • limited evidence on long-term workforce outcomes from neighbourhood integration
  • lack of consistent evaluation across different local models
  • limited insight into how workforce integration affects inequalities in access and experience.

Commentary
This programme learning highlights workforce integration as a central enabler of neighbourhood-level care. Strong relationships across health, social care and community organisations underpin the ability to deliver integrated, person-centred services.

Co-located teams and shared leadership arrangements are identified as practical mechanisms for overcoming workforce fragmentation. From a care equity perspective, these approaches can improve continuity and responsiveness, particularly for people with complex or multiple needs.

However, the findings also point to structural risks. Short-term and inconsistent funding, fragmented data sharing and limited investment in community infrastructure constrain the sustainability of neighbourhood integration efforts. These barriers may disproportionately affect deprived areas, where services are already under pressure.

The learning also raises important equity considerations around trust. High levels of integration with statutory services can risk weakening the independence and trust of community-led organisations if not carefully managed. In neighbourhoods where communities have historically felt let down by formal systems, this may undermine engagement rather than strengthen it.

Overall, the evidence suggests that neighbourhood integration depends as much on relational and cultural factors as on formal structures. Ensuring that workforce integration supports, rather than displaces, community leadership is likely to be critical for delivering equitable neighbourhood health and care.