Care homes and primary care in England working together: A multi-method qualitative study

In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships.

We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up.

Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants' understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice.

The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.