RESULTS
The leaflets we have produced and the other tools I have produced with regards to that, our assessment process, I think they are more user friendly. The information we are giving on the GP surgeries, they would not be able to get that if that had not happened. Now, all the six GP surgeries in my cluster, they have got the information on the dementia in different languages. The people, they can choose and pick whatever they want. The carers, or the patient, or anybody, they can look into those leaflets and they can go back to GP then refer to us. WIL3C, specialist practitioner nurse In another local attempt to improve joined-up working through explicit knowledge exchange, plans to train receptionists how to signpost patients were pursued. Chris spoke with the health promotion lead and this prompted the design of a short module (externalisation) by the borough-wide training co-ordinator: So we did three training sessions, the first one on 16 June was in the [Coxford 1] practice, and we had eight members from receptionists there, including one GP. On 29 June we went to [Westpark] practice, and it was just the practice manager and the business manager. And then on 20 July we went to [Coxford 2] practice, and there were eight members of reception and mid-team there . . . some people knew about some things, and other people didn’t. So you’ve got a mixed level of knowledge . . . . Because we were telling them about things that they weren’t aware about, all these things . . . the thing that came out to them was they wanted a general overview of the plethora of services available, because they knew about some, they didn’t know about others. WIP38L, health training co-ordinator This trainer spent considerable time trying to find out who to reach and how to develop an extranet as an area-wide resource, but IT support from the PCT was not forthcoming. As a result, the receptionist-training programme did not extend beyond the initial efforts described above. Practice managers blocked efforts to meet with receptionists in Westpark, stating time and space restrictions. Additional efforts floundered on mundane issues such as suitable meeting space, finding administrative support for invitations and flyers and logistical resourcing. Despite the creation and availability of local knowledge assets and support from WI leaders for disseminating health promotion information in the community, efforts continued to rely on passionate individuals and struggled to gain systemisation (combination). The training co-ordinator attempted to find funding and staff to build an intranet signposting resource, but with little success to date. When the team leader was made redundant, there was little momentum for the work and the PCT soon found other topics on which to focus.
Child and family health services With a broad agenda, individuals working to improve services for children also struggled to form a cohesive team (socialisation), particularly as joined-up working could potentially involve a wide array of professionals from several sectors. In an effort to connect the WI to broader community involvement efforts, stakeholder meetings were held in local area centres and a wide range of patient and public representatives were invited by to attend. For example, an experienced paediatric social worker and commissioner of paediatric services describes the need to continually ‘show up’ at meetings to advocate for children's programmes, particularly for teenagers aged up to 18 years who can be missed by planning efforts that focus on younger teenagers. If I know my job so well that I can recognise that there’s an inefficiency or a duplication, and I can get the people round the table who can actually say, ‘Yeah, you’re right’, and we can work together to put a pathway together that makes everything much more efficient, and again releases some capacity so someone can go off and do something else that’s needed, or some money that we can reinvest, that makes me happy . . . . Little things like I was in a substance misuse meeting yesterday, and we’ve worked really hard to integrate two services who 3 years ago were competitors, and both thought the other one was doing a crap job, and they could do it better, and, ‘Why don’t you just give me the money?’ And
84 NIHR Journals Library www.journalslibrary.nihr.ac.uk