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Abstract

Objective:

To identify competencies required for effective collaborative working within Primary Care Networks (PCNs).

Methods:

An online questionnaire about roles within PCN teams, importance of collaboration and experiences of connection and conflict within teams, was sent to Mental Health Practitioners (MHPs) and PCN/Practice Managers from several teams across Lancashire. Semi-structured interviews with similarly themed questions were conducted with MHPs, General Practitioners (GPs), and PCN/Practice Managers and analysed using reflexive thematic analysis. Questionnaire and interview data were combined, and themes were mapped onto 3 competency constructs (knowledge, skills and abilities, and personal characteristics).

Results:

Subthemes that were considered important to effective collaborative working in PCNs included: knowledge around shared goals, expectations, and role clarity; skills in communication and relationship building; embodiment of personal characteristics such as being engaged, accepting, and supportive.

Conclusion:

Clinical implications for promoting collaboration between staff working within PCN settings include meetings and joint training between PCN and NHS Trusts to establish network goals and expectations, regular team meetings and opportunities for face-to face activity to promote understanding of different roles and relationship building.

Keywords

collaborative working primary healthcare mental health professionals thematic analysis competency framework

Introduction

The NHS Long-Term Plan (LTP) recognises that the health needs of the UK population are continually changing, and offers commitment to transforming mental healthcare in England.¹ The NHS Mental Health Implementation Plan was established in 2019/2020, by 2023/2024, the framework pledged to deliver almost £1 billion additional annual funding to support mental health services in England.² The framework was designed to improve patient experiences and outcomes through the integration of physical and mental healthcare, and to ensure this transformation was developed at a local level.³ To meet local need, groups of general practices known as primary care networks (PCNs) work together to build upon existing services, including community, mental health, social care, pharmacy, hospital, and voluntary services.⁴

General practice is often seen as the ‘bedrock of the NHS’, however, practices face challenges, particularly around accessing services; appointment availability, waiting times, and the ability to meet with General Practitioners (GPs), particularly face-to-face (p. 3).⁵ The COVID-19 pandemic exacerbated intense workload pressures experienced by the NHS, not only across primary care, but specifically mental health services, due to an increase in mental health need.⁶ Therefore, since 2021, new Mental Health Practitioner (MHP) roles have been introduced in PCNs to help tackle challenges, manage local need, and provide quality mental healthcare.³ Practitioners are embedded within primary care, and are qualified professionals who provide support for adults with complex mental health difficulties, forming connections between general practice and specialist mental health services.⁷ These roles can be taken up by a range of professions; including community psychiatric nurses, clinical psychologists, mental health occupational therapists, or peer support workers. With their introduction, it is crucial that staff develop and utilise competencies that facilitate effective collaborative working to allow these roles to become embedded effectively in PCNs.³

Interprofessional collaboration is key across healthcare, the Interprofessional Education Collaborative (IPEC) provide a set of Core Competencies for Interprofessional Collaborative Practice. These competencies retain the overarching singular domain of ‘Interprofessional Collaboration’ comprised of; Values & Ethics, Roles & Responsibilities, Communication, and Teams & Team work.⁸ Models of primary care collaborative working include the Primary Care Behavioural Health model,⁹ which provides numerous strategies that teams can utilise to address patient need in a team-based and collaborative way. Prior research has demonstrated the importance of collaborative working within PCNs in providing good quality and efficient mental healthcare; open communication in particular is a key element in maintaining patient safety and positive patient outcomes. Models that include open communication as a key variable include TeamSTEPPS,¹⁰ which alongside communication, cites leadership, situation monitoring, and mutual support as key facets of collaborative primary care working. Weakness in interaction and communication between GPs and MHPs resulted in a lack of ‘mutual knowledge’ of mental health services. These, particularly regarding access to communication channels, are likely to reduce the frequency of practitioners seeking necessary support, suggesting communication problems could be detrimental to service quality.^11
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There is a risk that silo working between MHPs and GPs could contribute to reduced healthcare quality and practitioner isolation. For example, the salience of ‘occupational isolation’ experienced by GPs in primary healthcare centres due to feeling excluded from their work community.¹⁷ Components highlighted in research, including the need for independent decision-making and a lack of feedback and mentoring associated with occupational isolation may be particularly pertinent to new and emerging MHP roles as they enter the PCN workplace.¹⁷

Good collaboration, in particular trust and respect between practitioners, is significantly associated with increased job satisfaction amongst nurses.¹⁸ The value of strong working relationships amongst peers can be expected to be equally important for new MHPs working within PCNs. Research has found that overall job satisfaction amongst healthcare professionals has had significant negative effects on intentions to quit.^19,20 Given this, it is vitally important that the development and deployment of MHP roles into primary care is scaffolded and supported so the investment made into the workforce is protected, as well as to support staff welfare. This will alleviate risks of silo working, miscommunication, misunderstanding of job roles and joint care planning.

As the PCN landscape changes, and primary mental healthcare is transformed through new MHP roles introduction, there is a gap in understanding how PCN staff can effectively work together. MHPs are already deployed in PCN settings within the North-West and this evaluation is needed. The primary aim of this service evaluation was to explore which competencies are required for effective collaborative working within PCNs from the perspectives of primary care staff members; including MHPs, GPs, and PCN/practice managers.

Methods

Ethical Considerations

As the project evaluated an ongoing workforce initiative, ethical approval for research was confirmed as not necessary. The project was registered with the Trust’s Research and Development department as a service evaluation.

Design

An online survey and semi-structured qualitative interviews were used.

Setting

Participants were recruited from a Mental Health NHS Trust in the North-West of England, where there are 41 PCNs serving an aggregated population of 1.6 million, the largest has a patient list of over 90 000 individuals.²¹ Within this Trust, PCNs can employ MHPs of different levels of responsibility from Bands 5 to 7; higher bands typically have more clinical and operational responsibility.²²

Participants

all participants were sampled by invitation and opportunity for both questionnaire and interviews, the basis for this invitation was a combination of targeting and convenience with the aim to capture only the relevant population. The denominator of the participant population is that all participants work in PCNs in the North-West of England. These included band 5 and 6 MHPs, GPs, and PCN/practice managers. The inclusion of multiple workforce groups allowed for different perspectives of collaboration, drawing upon different trainings, responsibilities, and expertise.

Procedure

All GPs in the regional Integrated Care Board area were contacted by the lead GP. Approximately 30 PCN managers were additionally invited to take part in the questionnaire evaluation via email. These contacts were asked to cascade the email to their staff, in particular MHPs in their practice. However, the evaluation received low response rate. A secondary email was shared inviting participants for interviews. Interested individuals were asked to contact the project team to get further information and were then consented to take part. The questionnaire portion of the evaluation was conducted first and was used to gain a wide picture of the views of participants; the interviews followed with the intention of gaining further and deeper understanding on the topics in question. Questionnaires were anonymous so there was the chance that participants completed both the questionnaire and also took part in the interview, without researchers being aware. Prior to completing questionnaires or interviews, participants were emailed a Participant Information Sheet. This informed interview participants of actions that would be undertaken to manage risk or disclosures of malpractice. They were encouraged to contact the project team for further information as required.

Questionnaire

Two online questionnaires were created via Google Forms and disseminated via NHS email to all relevant staff groups inviting them to take part. PCN/practice managers were also asked to forward the questionnaire and accompanying documents to their staff lists. Questionnaire participants completed a consent form embedded into the Google Form as a condition of accessing the questionnaire. Questionnaires were completed anonymously. Participants completing the online questionnaire were made aware of the fact that once their responses had been submitted their data could not be withdrawn, as it would not be attributable to them.

The questionnaire used was created specifically for this study, and was informed by previous literature and discussions with MHPs about their role. This included open discussions in relevant meetings about important areas to talk through, including areas of current practice and evident gaps. Some questionnaire sections were adapted for each workforce group; 1 questionnaire was completed by MHPs and the other PCN/practice managers (see Supplemental File 1). Both questionnaires included a combination of open and closed questions. These questions asked about (a) roles within the PCN and understanding of these roles, (b) importance of these roles working together, (c) feelings of connection within teams, and (d) any challenges and learning from experiences of collaborative working. Questions in the MHP questionnaire asked about collaboration between MHPs, and the PCN/practice managers’ questionnaire was specifically focussed on collaboration between PCN management and MHPs.

Interviews

Relevant staff groups were invited to take part in interviews via email, interested participants contacted the project team. Interview participants were provided with a copy of the consent form to be signed and returned to the project team. Interview participants were made aware of their right to withdraw from the interview at any point, and that their data could be withdrawn prior to anonymisation. Following anonymisation, their data could no longer be withdrawn. Semi-structured interviews were conducted by an Assistant Psychologist between May and July 2023.

Interview topic guides were written specifically for this study and were informed by previous literature and discussions with MHPs about their role. This included open discussions in relevant meetings about important areas to talk through, including areas of current practice and evident gaps. Topic guides were adapted for interviewing the different workforce groups, topics were the same as the online questionnaire, though the phrasing differed due to the format (see Supplemental File 2). Interviews were conducted by video call and audio recorded via MS Teams, with auto-transcription enabled, and edited afterwards by Assistant Psychologist to ensure accuracy and remove identifiable information.

The questionnaire portion of the evaluation was used to gain a wide picture of MHPs and PCN/Practice managers views; the interviews followed this with the intention of gaining further understanding on the topics in question.

Analysis

Closed question data was collected via the Google Forms built in feature which calculated percentages.

Reflexive Thematic Analysis was used for the data analysis of interview transcripts and open-ended questionnaire responses.^23,24 This was deemed suitable as an analytic method given the exploratory nature of this evaluation, the subjectivity of the data, and exploration of participants’ lived experiences.²⁵ Marrelli et al²⁶ discussed 3 constructs for developing competency models: (i) knowledge, (ii) skills and abilities, and (iii) personal characteristics. Data was coded and mapped onto these constructs using a deductive approach. Data was further coded inductively into refined sub-themes within the constructs driven by participant responses. Analysis took place in NVivo 12. Coding was completed by 2 Assistant Psychologists, who independently coded transcripts, before conferring to resolve discrepancies.

Results

Nine participants were interviewed: N = 3 MHPs, N = 3 GPs, and N = 3 Practice Managers. Mean interview duration was 24 min (range = 12-40 min). Eleven participants completed questionnaires: N = 9 MHPs, N = 1 PCN Manager, and N = 1 Practice Manager.

Closed questionnaire questions asked both MHPs and PCN/Practice Managers if they felt their team was made up of appropriate roles/skill-set mix; of interest was the finding that 100% of PCN Managers responded that their current team of MHPs was made up of an appropriate mix of roles/skill-sets, whereas only 66.7% of MHPs reported the same. Additionally, all PCN/Practice Mangers asked responded that they felt they had a good understanding of the different roles of MHPs within their teams. MHPs were asked if they had experienced conflict working with staff in their PCNs; 44.4% responded yes.

The following section describes findings from interview transcripts and open-ended questionnaire data. Table 1 outlines the themes and subthemes reported by staff groups about what was considered important to deliver effective collaborative working within a PCN.

Table 1.

Overview of Themes and Subthemes.

Theme	Subtheme
Knowledge	Shared goals and expectations Understanding the PCN goals and what is expected from MHP in achieving them.
Knowledge	Role clarity PCN staff’s understanding of the different MHP roles, their individual competencies and capacities.
Skills and abilities	Communication and relationship-building Ability to effectively communicate and build strong working relationships in collaboration.
Personal characteristics	Service Level Engagement PCN and Trust management engaging with the integration of MHPs via regular communication and support.
	Accepting PCN staff being accepting of change and welcoming MHPs into PCNs.
	Supportive MHPs supporting PCN staff and one another to provide collaborative, integrated care.

Knowledge

Clear understanding of shared PCN goals, and the expectations of MHPs and PCN staff roles in achieving these goals, were considered important. This was seen as required for successful, efficient integration of new roles, which would facilitate effective collaborative working to meet need.

Shared Goals and Expectations

Participants agreed on the necessity for shared understandings of PCN goals and ways of working to achieve them. Some participants reported that a lack of shared understanding had led to confusion when introducing MHPs into PCNs, due to a misalignment of expectations between MHPs, Trust, and PCN management.

Having another MHP join, they’ve always come with their views and their ideas but we’re able to work together to implement them and make it work for all of us. But . . . [Trust and PCNs had] different expectation[s]; it could have been organised a bit better where the PCN and [NHS Trust] were meeting and having the talks before we were actually put in position. (MHP 3)

If you don’t set out from the very beginning what your expectations are as a PCN, if you don’t agree what your criteria is, what your protocols are, what your pathways are, then you will just set them [MHPs] up to fail. (PCN manager 3)

MHPs generally reported positive experiences of establishing shared knowledge amongst fellow MHPs. Some participants agreed that their PCN’s approach to the introduction of MHPs required further development. Some participants highlighted the difficulties of MHPs being ‘pulled both ways’ (GP 1) when they joined PCN settings from secondary care services. They noted the need to identify and directly address these differences, to adapt their ways of working accordingly.

[Practitioners are] used to working in an extremely different way, so when they arrive on the ground in practices, assumptions on both sides don’t match very well [. . .] because they don’t understand the [new] way of working and the practice staff don’t understand the way that they’ve been used to working. (GP 1)

The efficiency of successful integration of MHPs into PCNs was seen as reliant upon early groundwork to ensure they understood the expectations of their roles. Joint training and supervision with NHS Trust and PCN management was recommended to address misunderstandings. One example included misalignment between financial pressures and what care could be provided.

There [are] some issues . . . [with] psychological work . . . where it has to be value for money, so that adds pressure to push certain things even though . . . they’re supposed to be patient led. (MHP 2)

Despite acknowledging the benefit of new MHP roles in reducing caseload pressures, some participants felt strongly about ensuring that PCN staff agreed about the priorities for quality of patient care, as well as quantity of patients seen.

Role Clarity

Knowledge about MHP roles was seen as important in understanding how MHP services could be appropriately utilised alongside other PCN services to meet need.

[Some practices are] expecting a little bit more from their MHP, expecting them to go a little bit beyond and out of their boundaries, and that’s one of the challenges. (PCN manger 1)

Participants discussed how PCN staff’s lack of clarity around MHP roles could hinder effective collaboration. This included differentiating between practitioners and understanding capability and capacity. Some participants believed further efforts were needed for PCN staff to reach a shared understanding of the position of MHPs within PCNs, their role outlines, and appropriate service utilisation. This knowledge was seen as particularly important to ensure appropriate referrals to MHPs, avoiding frustration and inefficiency. Establishing clear referral criteria and pathways was important to tackle incorrect interpretations of role responsibilities.

Some participants acknowledged the difficulty of rigidly defining MHP roles due to the complexity of their work and variations in individual attitudes, skills, and ways of working.

I understand that you can’t define the role and roll it out exactly the same in each PCN, because each PCN, even each GP practice, can run differently and have different expectations so you have got to be very flexible and very fluid with the role, but just [have] some underlying consistency. (MHP 3)

It is suggested that GPs particularly needed to develop this knowledge. Some GPs acknowledged that, due to their position outside of the mental health workforce, there was a lack of thorough understanding of differences between MHP roles and teams. It was suggested that ‘oversight from the Band seven for appropriate distribution of work within the PCN mental health team’ (GP 1) was required to facilitate consistent collaborative working within PCNs.

Skills and Abilities

The importance of clear, regular, and open communication is beneficial for the development of strong working relationships. This was seen as important for ensuring connection and support, understanding expectations and roles, and efficiency of collaboration within mental health teams.

Communication and Relationship-Building

MHPs generally reported feeling sufficiently connected to and supported by their peers. They agreed upon the importance of regular meetings and open lines of communication amongst mental health teams to build trusting working relationships. Away days and virtual team meetings were valued for developing a ‘sense of comradery’ (MHP 10) across PCN mental health workforces.

If you don’t have confidence in your partner then it’s extremely difficult and you would hesitate every time you want to do something . . . unless you get to know people properly, it’s very difficult to work and trust is important at the end of the day. (GP 3)

MHPs reported on a lack of training opportunities to enhance their abilities to work collaboratively. They identified some opportunities for relationship-building, such as peer mentor training, setting up NHS Trust and PCN staff meetings, and clinical supervision. The representation of mental healthcare via MHPs working within MDTs was recommended for developing links. Sharing referral worklists allowed mental health teams to work together to manage patient care. This included assessing suitability and crossover, responding in cases of urgency or absence, and for higher banded roles to have clear oversight. MHPs mentioned the use of a virtual message board to ensure information required for collaborative working was up-to-date and accessible.

Despite acknowledging the efficiency of virtual team communication, participants discussed the importance of face-to-face collaboration. A GP recalled the success of a ‘practice learning time’ event as an opportunity for PCN staff from different services to meet and educate one another about their roles.

People remember more from something like that, when they’ve actually seen the workers, they’ve had it clearly explained to them at an event, rather than just seeing something on an e-mail or in a document. (GP 2)

In-person events were seen as beneficial in cultivating positive working relationships.

Personal Characteristics

Particular attitudes, values, and traits were seen as important for staff to develop for collaborative working within evolving PCNs. An increased need for engagement from management staff and acceptance of change from general practice staff was identified. The value of MHP services within PCNs has led to a desire for expansion of the workforce.

Service Level Engagement

Levels of satisfaction with PCN and NHS Trust management support varied. Participants acknowledged the many pressures of working and leading within PCN settings. Yet, some MHPs perceived some managers’ lack of time to engage with MHPs as a challenge to their integration within PCNs.

The most common challenge is that [practice managers] are very busy and we are not a “priority” for their business needs so they can often be unresponsive, however, some are very welcoming and try to make you feel part of their team. (MHP 5)

Those who had had more positive experiences noted the value of consistent check-ins, providing their own feedback, and receiving reassurance. Those less satisfied expressed frustrations with inconsistent email correspondence and missed meetings. Some MHPs explained how efforts to work with other practitioners to meet patient need had often occurred as a result of their own initiatives as opposed to PCN management guidance.

In turn, some PCN/practice managers expressed frustrations with working alongside the NHS Trust. They described a lack of involvement and responsiveness, feeling ‘a little bit done to, rather than with’ (PCN manager 3). They expressed a desire to be included in the early stages of the MHP employment process and provided with guidance from the NHS Trust on how to support the mental health workforce with its PCN integration.

Accepting

PCN staff’s acceptance of the new mental health workforce and its place within PCNs was seen as required for welcoming and co-operating with MHPs. Participants felt it was important for PCNs to prepare for the introduction of MHPs, ensuring suitable facilities and resources to accommodate the roles. One MHP felt the MHP role was considered an ‘afterthought’ in 1 practice (MHP 2).

It largely depends on the practice, the sort of reception you get . . . in the third practice I’m going to . . . there is a bit of a lack of respect for [MHPs] . . . I’ve been put in a file room and that really frustrates me because it’s unprofessional and it’s just not pleasant. (MHP 2)

Participants described challenges with integrating MHPs into PCNs, such as them taking on responsibilities that were previously held by others. Some tension between MHPs and some of the more established, experienced general practice staff was acknowledged to have developed as a result of these changes. They highlighted the potential for focussed training to support staff in adjusting to and accepting change within PCNs.

A lot of GPs have struggled, not only with the loss of autonomy . . . because it takes away their direct control over those staff, but also, some GPs are better than others at respecting and working with people from different professional backgrounds, and I think it is possible to train people up in that. (GP 1)

Some MHPs reported positive experiences of working with GP staff, feeling recognised, trusted, ‘respected, and [seen] as a specialised professional’ (MHP 3). They noted the benefits of allowing MHPs to take the lead in establishing their new roles within PCNs.

I have found Primary Care to be a very supportive environment full of proactive members of staff who celebrate changes being made and trust professionals to carry out their roles. (MHP 8)

I feel that we were put in those situations [as new roles within PCNs] to develop it ourselves, . . . I’ve really been able to embed it and make it mine. (MHP 3)

As opposed to attempting to fit into PCNs as they were, it was seen as important that MHPs could have flexibility with developing their roles and work together with PCN staff to align and accept different ways of working.

Supportive

Participants acknowledged the intense demand for mental healthcare within PCNs and the challenge of managing workload and waiting lists. Working together to alleviate this pressure was seen as a key purpose of the introduction of MHPs. Some participants emphasised the importance of focussing on the value of MHPs in ‘offering high quality, more experienced care’ (GP 2) to meet presenting need.

If we get it right, the real magic of [MHP] roles is, not only are we giving that extra capacity which we really need, we are also bringing some extra skill and knowledge into primary care. (GP 2)

Participants appreciated the value of MHPs in providing mental healthcare services and expressed a desire to expand the mental health team within their PCN.

Being a band five practitioner, there’s things that I can and can’t do so having somebody else who is a band seven and is able to give me their experience, knowledge, support is really, really helpful. (MHP 1)

MHPs expressed satisfaction with receiving support from fellow MHPs when working together to provide care. They highlighted the value of collaborative working between different MHP roles, sharing their varied expertise and skill-sets when referring within the team, particularly those of higher banding supporting those of lower banding. A band 5 MHP credited feeling more at ease due to support received from experienced practitioners.

Discussion

With the relatively new introduction of MHPs within Primary Care and these shifting workforce structures, the current paper presents the findings of a qualitative service evaluation exploring the competencies that MHPs and PCN staff felt were important in facilitating collaborative working within PCNs. Nine interviews and 11 questionnaires were completed by MHPs, clinical supervisors, GPs, and PCN management staff.

Findings highlight the challenges experienced by staff following the introduction of MHPs into PCNs. A lack of shared understanding of PCN goals was identified, particularly when there were differences or conflicts of interest between the PCN and NHS Trust regarding expectations of MHPs. With the introduction of new ways of working between services that have historically been quite separate, such challenges and tensions may be reasonably expected.

In order to overcome and mitigate against such challenges, early groundwork was identified as key to the integration of MHPs into PCNs; particularly to address expectations of their roles. Findings also highlight the challenges experienced by staff associated with a lack of role clarity and understanding amongst PCN teams. This aligns well with the ‘Roles & Responsibilities’ competency from the IPEC, which addresses the use of knowledge of one’s own role and team members’ expertise to address individual and population health outcomes.⁸

The interviews identified communication and relationship-building as challenges for some PCNs. Aligning with the TeamSTEPPS model of collaborative working,¹⁰ open lines of communication were noted by participants as important. Staff noted varied levels of satisfaction with PCN and NHS Trust management support. Those who reported positive experiences referenced the presence of consistent check-ups, feedback, and reassurance.

Effective collaborative working amongst PCN staff was attributed to the success of MHP integration within PCNs. Lack of shared expectations about MHP roles was seen as a barrier to consistency when working with PCN staff. Positive experiences of collaborative working involved increased engagement from PCN management and acceptance of change from GP staff. MHPs generally reported positive experiences working within their mental health teams and the benefits of building relationships and supporting one another.

This paper’s findings suggest that opportunities for staff to exchange knowledge about their roles is important for consistency within collaborative working. The development of working relationships encourages collaboration, and the clarification of role expectations reduces confusion and frustration when working together to meet need. This is consistent with previous research and established models emphasising the importance of GPs strengthening competency in creating ‘mutual knowledge’ with MHPs through the development of accessible and consultive working relationships.^10,13 Weakness in interaction and communication were found to have a consequent effect in reducing the desire for MHPs to collaborate, which could impact patient care.¹³

In addition, the findings of this paper outline the value of consistent engagement from PCN and NHS Trust management. This corresponds with Herd et als’²⁷ research suggesting recognition, reward, and positive role modelling are an effective way for leaders to engage with healthcare staff. Given that MHPs within primary care is a recent development, this reflects the importance of engagement from NHS Trust and PCN management to improve efficiency of the integration of MHPs into PCNs.

This paper identified that GPs acknowledged a lack of understanding about the different ways MHPs work in PCNs compared to their own. The need for mental health staff and physicians to respect the work culture variations between these roles has been highlighted in the literature; particularly value systems, practice styles, and orientations to time; suggesting that mutual understanding and respect for the difference between roles is integral for positive relations and collaboration between these staff groups.²⁸

Also within current paper findings; clear goals, ongoing team-building efforts, and open communication are needed to facilitate effective collaboration, which is consistent with Reeves’ findings within accounts of inter-professional teamwork. Reflections on its success need to include aspects related to acceptance, such as motivation to learn and share from one another, mutual respect, and team commitment.²⁹ Sharing knowledge and learning from one another are important collaborative ingredients, and should consistently feature in these new working relationships.

Findings also suggest progress with the LTP aims in introducing MHPs within PCNs. Collaborative working to meet mental healthcare demands was seen as beneficial for both reducing workload pressures and improving quality of care. In accordance with existing literature, findings of the current paper highlight collaborative working also improves healthcare staff welfare in ensuring they feel well-connected and supported.^19,20

Study strengths included recruitment of multiple primary care workforce groups, bringing a variety of perspectives. However, a relatively small sample was recruited from opportunistic sampling from North-West PCNs and GP staff, and PCN/NHS Trust management remained under-represented. This introduces potential biases and limits the generalisability of the findings outside of the host NHS trust. Discussions with relevant groups/colleagues after the service evaluation indicated that the time of year led to a low response rate, as well as external local pressures. It is also plausible that those staff members that had important contributions to this evaluation may have been too busy, or felt unable, to take part. Future research would be beneficial to further explore these challenges from the perspectives of PCN and NHS Trust management, and to incorporate the voices of more staff.

Demographics were not included in data collection for this study, this was due to the focus being on the system rather than individual participants. Future research may benefit from including this information to help further understand perspectives of staff.

Remote interviews allowed for greater convenience and scheduling flexibility for participants, whose time was often limited and unpredictable. However, unlike in-person interviews, it may have limited the ability to build rapport and observe context. Due to some members of the project team being senior staff members within the participating NHS Trust, participants with critical perceptions and concerns may have been less willing to share these and spoken more favourably of their experiences. Therefore, there may be future utility in such evaluations being completed by those not directly part of the workforce initiatives, to reduce this possibility.

Future studies would be required to continue this line of research; a Delphi Study³⁰ would be recommended in this case to collect data and perspectives of individuals with an expertise in the topic area. Future study would require collection of data across multiple survey rounds in an iterative co-learning fashion.

Clinical Implications

The findings of this paper describe several opportunities for PCNs to promote good collaborative working with local NHS Trusts. The implementation of meetings between PCNs and the NHS Trust prior to the recruitment of MHPs, and to outline different expectations of the roles and the goals set by both parties, may be a beneficial step towards shared goals and expectations. This would allow for early communication and resolution of any foreseen challenges to integration, enabling a proactive rather than reactive approach to change management. Furthermore, the pursuit of joint training and supervision between PCN management and NHS Trusts may have multiple benefits. New team members would gain important knowledge about PCN values and demands so they can embed themselves into teams effectively and allow for any discrepancies or contradictions in service policy between the NHS Trust and the PCN to be resolved early on.

Another sensible implication from the findings of the paper is setting up regular team meetings within the PCN. Face-to-face meetings arranged in individual GP surgeries may provide staff with working knowledge of who is available in the surgery and their roles/responsibilities. The implementation of regular team meetings may also provide opportunity for MHPs to provide feedback on referral processes and remind wider staff groups of the capabilities and capacities they hold within the surgery setting.

Prioritising opportunities for effective communication should be considered as a priority for PCNs to address these challenges. This could be via virtual means (eg, message boards) or face-to-face collaboration, for example, arranging in-person team meetings. Participants acknowledged the value of in-person events (including team away days) to build positive working relationships. Whilst there is a time implication associated with this, the opportunities for strengthening working relationships and building constructive channels of communications may prove to be a good investment in the longer term, to reduce miscommunication, improve efficiency, and ultimately benefit patient care.

Responding to the sub-theme of ‘accepting’ highlighted from interviews, PCNs may consider evaluating their readiness to employ a MHP before completing recruitment. Ensuring that practitioners have suitable spaces to work and resources available may increase MHPs’ sense of value within the PCN team. This may, in turn, benefit collaboration and amity amongst staff members.

Conclusion

The service evaluation detailed in this paper found that open and effective communication, engagement from both PCN management and NHS Trusts, and ongoing team building efforts were important for positive and productive collaboration between staff. Evaluation findings have identified practical strategies to be considered that can further support collaborative working. These include the implementation of meetings between members of PCNs and the NHS Trust prior to MHP recruitment to assess operational readiness and increasing the number of opportunities for communication within teams to aid understanding of different roles and skill-sets. These potential strategies aim to helpfully influence collaborative working within PCNs, to support the assimilation of new MHP roles into existing primary care structures. Future directions for further research would include embedding suggestions from this paper into primary care settings and their impact on the development of collaborative working between staff.

Supplemental Material

sj-pdf-1-jpc-10.1177_21501319251392536 – Supplemental material for Understanding Collaborative Working Within Primary Care Networks: An Exploration of The New Mental Health Workforce

Supplemental material, sj-pdf-1-jpc-10.1177_21501319251392536 for Understanding Collaborative Working Within Primary Care Networks: An Exploration of The New Mental Health Workforce by Asira Bhikha, Kate Allsopp, Molly S. Lever, Miranda Budd, Gita Bhutani and Brendan J. Dunlop in Journal of Primary Care & Community Health

Supplemental Material

sj-pdf-2-jpc-10.1177_21501319251392536 – Supplemental material for Understanding Collaborative Working Within Primary Care Networks: An Exploration of The New Mental Health Workforce

Supplemental material, sj-pdf-2-jpc-10.1177_21501319251392536 for Understanding Collaborative Working Within Primary Care Networks: An Exploration of The New Mental Health Workforce by Asira Bhikha, Kate Allsopp, Molly S. Lever, Miranda Budd, Gita Bhutani and Brendan J. Dunlop in Journal of Primary Care & Community Health

Footnotes

Acknowledgements

Authors would like to acknowledge and thank staff members from the Primary Care Networks who supported this project and gave their time to complete the project questionnaire and be interviewed about their experiences.

ORCID iDs

Molly S. Lever

Gita Bhutani

Brendan J. Dunlop

Ethical Considerations

Consent to Participate

Informed consent to participate was written.

Consent for Publication

Not applicable.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

NHS England. The NHS Long Term Plan. 2019. Accessed August 15, 2023. https://www.longtermplan.nhs.uk/wpcontent/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

NHS England, NHS Improvement & National Collaborating Centre for Mental Health. The Community Mental Health Framework for Adults and Older Adults. 2019. Accessed August 15, 2023. https://www.england.nhs.uk/wp-content/uploads/2019/09/community-mental-health-framework-for-adults-and-older-adults.pdf

NHS. NHS Mental Health Implementation Plan 2019/20-2023/24. 2019. Accessed August 15, 2023. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-2023-24.pdf

NHS England. Primary Care Networks. 2023. Accessed August 24 2023. https://www.england.nhs.uk/primarycare/primary-care-networks/

NHS. Our plan for improving access for patients and supporting general practice. 2021. Accessed August 24 2023. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/10/BW999-our-plan-for-improving-access-and-supporting-general-practice-oct-21.pdf

The King’s Fund, Centre for Mental Health. Mental health and primary care networks: Understanding the opportunities. 2020. Accessed August 25 2023. https://www.kingsfund.org.uk/publications/mental-health-primary-care-networks

NHS England. Mental Health Practitioners. 2023. Accessed August 25 2023. https://www.england.nhs.uk/mentalhealth/working-in-mental-health/mental-health-practitioners/

Interprofessional Education Collaborative. IPEC Core Competencies for Interprofessional Collaborative Practice. IPEC; 2023. Accessed August 24 2023. https://www.ipecollaborative.org/assets/core-competencies/IPEC_Core_Competencies_Version_3_2023.pdf

Reiter

Dobmeyer

Hunter

. The Primary Care Behavioral Health (PCBH) model: an overview and operational definition. J Clin Psychol Med Settings. 2018;25(2):109-126. doi:10.1007/s10880-017-9531-

10.

King

Battles

Baker

, et al. TeamSTEPPSTM: Team Strategies and Tools to Enhance Performance and Patient Safety. Nih.gov. 2008. Accessed August 24 2023. https://www.ncbi.nlm.nih.gov/books/NBK43686/

11.

Fredheim

Danbolt

Haavet

, et al. Collaboration between general practitioners and mental health care professionals: a qualitative study. Int J Mental Health Syst. 2011;5:1-7. doi:10.1186/1752-4458-5-13

12.

Fay-Hillier

Regan

Gallagher Gordon

. Communication and patient safety in simulation for mental health nursing education. Issues Mental Health Nurs. 2012;33(11):718-726. doi:10.3109/01612840.2012.709585

13.

Hamaideh

. Mental health nurses’ perceptions of patient safety culture in psychiatric settings. Int Nurs Rev. 2017;64(4):476-485.

14.

Kanerva

Kivinen

Lammintakanen

. Communication elements supporting patient safety in psychiatric inpatient care. J Psychiatr Mental Health Nurs. 2015;22(5):298-305. doi:10.1111/jpm.12187

15.

Belyansky

Martin

Prabhu

, et al. Poor resident-attending intraoperative communication may compromise patient safety. J Surg Res. 2011;171(2):386-394. doi:10.1016/j.jss.2011.04.011

16.

Rosenstein

O’Daniel

. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464-471. doi:10.1016/S1553-7250(08)34058-6

17.

Aira

Mäntyselkä

Vehviläinen

, et al. Occupational isolation among general practitioners in Finland. Occup Med. 2010;60(6):430-435. doi:10.1093/occmed/kqq082

18.

Ylitörmänen

Turunen

Mikkonen

, et al. Good nurse–nurse collaboration implies high job satisfaction: a structural equation modelling approach. Nurs Open. 2019;6(3):998-1005. doi:10.1002/nop2.279

19.

Scott

Gravelle

Simoens

, et al. Job satisfaction and quitting intentions: a structural model of British general practitioners. Br J Ind Relat. 2006;44(3):519-540. doi:10.1111/j.1467-8543.2006.00511.x

20.

Shields

Ward

. Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. J Health Econ. 2001;20(5):677-701. doi:10.1016/S0167-6296(01)00092-3

21.

Budd

Gardner

Bhutani

, et al. Can a new role, the (Trainee) Associate Psychological Practitioner (T/APP), add value in General Practice? Results from the pilot year evaluation. Prim Health Care Res Dev. 2022;23:e61. doi:10.1017/S1463423622000482

22.

Lord

Gardner

Budd

. Associate Psychological Practitioners (APPs) in Primary Care-Modelling the Impact. 2025. Accessed August 15 2025. https://wrapt.org.uk/portfolio-items/radiology-north-cumbria-university-hospital-3-2-3/?portfolioCats=21%2C22%2C23%2C38

23.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa

24.

Braun

Clarke

. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):37-47. doi:10.1002/capr.12360

25.

Braun

Clarke

. Conceptual and design thinking for thematic analysis. Qual Psychol. 2022;9(1):3. doi:10.1037/qup0000196

26.

Marrelli

Tondora

Hoge

. Strategies for developing competency models. Adm Policy Ment Health. 2005;32(5-6):533-561. doi:10.1007/s10488-005-3264-0

27.

Herd

Adams-Pope

Bowers

, et al. Finding what works: leadership competencies for the changing healthcare environment. J Leadersh Educ. 2016;15(4):217-233. doi:10.12806/V15/I4/C2

28.

Fickel

Parker

Yano

, et al. Primary care–mental health collaboration: an example of assessing usual practice and potential barriers. J Interprof Care. 2007;21(2):207-216. doi:10.1080/13561820601132827

29.

Reeves

Lewin

Espin

, et al. Interprofessional Teamwork for Health and Social Care. John Wiley & Sons; 2011.

30.

Barrett

Heale

. What are Delphi studies? Evid Based Nurs. 2020;23(3):ebnurs-2020-103303. doi:10.1136/ebnurs-2020-103303

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