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The workforce engaged in providing integrated care is wide and diverse – alongside registered professions such as nurses, occupational therapists, social workers, and doctors, are skilled practitioners working within the frontline delivery of health and care services and those within voluntary and community sector organisations. An integrated workforce does not lose the distinct skills and knowledge of these different roles but rather facilitates a more co-ordinated approach which builds on their individual strengths to provide more joined- up and person-centred care.
An integrated approach requires a strategic understanding of the needs of the population to then model the required contribution of different professionals and practitioners. Employers across the related sectors work together to ensure that there is the appropriate capacity, skill mix and career pipelines in place. This may involve new roles being developed or existing roles being reconfigured to some extent. Members of an integrated workforce need the skills and knowledge to successfully collaborate in formal and informal teams. It is also important to recognise the vital contribution of unpaid groups within the extended workforce such as family members and volunteers.
The most important resource to facilitate more integrated care are the professionals and practitioners who work in the related services. They bring the skills, knowledge and values which will ensure that people and their families feel respected, listened to, and engaged as equal partners. Without sufficient capacity and skill mixes and staff support, strategic plans to better integrate care will not be implemented. Major gaps in staff recruitment and retention of any of the major professions or practitioner roles will result in delays in accessing services which will not be addressed even with better co-ordination and communication. An insufficient and unsupported workforce will also result in a stressful environment for staff to work within, with negative impacts of their health and wellbeing.
An integrated workforce requires a clear vision and shared values with engagement from across the health and care system. A joint plan is required based on population needs, workforce modelling and the perspectives of staff and people with lived experience. Transparency in the assumptions of these plans with identified points of review will enable stakeholders, including those representing different professions and workgroups, to understand the underlying thinking and contribute their insights. Job descriptions and appraisal systems should reflect different roles’ contributions to more integrated care and improved outcomes. The physical environment and digital infrastructure should also be considered as important enablers to more effective practice.
Integrated care requires opportunities for professionals and practitioners to develop the underpinning skills and continually improve their practice. This will involve formal and informal learning opportunities including individual and group reflection. Education providers must be engaged to ensure that initial training and qualifications, and on-going professional development opportunities, reflect the required collaborative competences. This will also mean teaching faculties being confident in how to facilitate new opportunities for learning. This should include inter-professional education which can help staff to gain collaborative skills and better understand the roles of other professionals. Involvement of people with lived experience within education programmes provides important insights into how professionals and practitioners can be more person-centred.
There is considerable evidence that insufficient workforce capacity and skills, a lack of clarity regarding respective roles and responsibilities, blame-based cultures, and performance and incentives focused on siloed working, will affect the quality of practice, and so prevent the potential benefits of integration being realised. There is also evidence that inter-professional education can facilitate professionals and practitioners developing the skills of collaboration necessary for more co-ordinated care. There is though little evidence to date as to the impacts of alternative approaches to strategic planning of an integrated workforce and what will work better in different contexts.
