LAUSR

Aims Vertical integration describes primary and secondary care working closely together to provide joined-up healthcare services for patients. There have been attempts to vertically integrate paediatric services since the 1950s, but these have been routinely de-implemented due to shifting managerial and commissioning priorities. Recently, the NHS Long Term Plan articulated a renewed aspiration to vertically integrate paediatric services. This study aims to characterise the barriers and enablers to vertically integrating paediatric services, and to contextualise these within current NHS policy to produce meaningful insights for clinicians, managers and policymakers. Methods Participants were selected using purposive sampling. Twenty-two paediatric professionals (16 paediatricians, 3 GPs, 2 nurses and 1 commissioner) were selected, who had experience of integrated care and were in the latter stages of their career. Semi-structured interviews were performed focussing on their experiences of vertical integration in paediatrics. Transcripts were thematically analysed to identify barriers and enablers to vertical integration. Themes were ordered into three categories: (1) factors affecting individuals, (2) factors relating to local policy or management and (3) factors relating to national policy or politics. Results At individual level, barriers included: (i) Clinicians’ skills, including discomfort of some paediatricians with the risk in primary care and some GPs lacking detailed paediatric knowledge, and (ii) a lack of time in clinicians’ schedules for collaborative work. Enablers included: (i) Strong relationships between primary and secondary care clinicians; (ii) good communication between clinicians and (iii) co-location of clinicians’ working environments. At local level, barriers included (i) perceptions that managers lacked knowledge of vertical integration; (ii) a perceived lack of evidence to support vertical integration; and (iii) restrictive organisational structures. At a national level, barriers included (i) perceptions that the public and politicians viewed hospitals as the ultimate goal of healthcare, impeding efforts to move or share resources; and (ii) a perceived lack of value placed on children by broader society. Conclusions Our findings highlight that vertically integrating paediatric services requires overcoming barriers at multiple levels. We also describe some enablers of integration. These findings are highly relevant in the current policy environment and will be instructive to clinicians, managers and policymakers involved in integrating services in the future.