Barriers and opportunities for developing sustainable relationships for health improvement: The case of public health and primary care in the UK

Abstract The British National Health Service has enjoined public health and primary care via a series of policy initiatives. Inter-organizational relationships provide the foundation for managing the system changes required to deliver policy, but are often taken for granted. This article reports on a study that sought to answer three key questions. First, which relationships are important for improving health? Second, what are the key areas in these relationships that might impact on delivery of improved public health? Third, what issues should be addressed in developing emerging relationships? Following a questionnaire to a sample of primary care organizations and a series of intensive workshops with key informants, findings indicate that there is an extensive network of relationships in which public health staff may participate. However, active participation is problematic in terms of identifying the most relevant relationships and ensuring protected time to develop these. Key relationship dimensions impacting on improved public health included different organizational perceptions of relationships and limited mutual understanding. However, despite a lack of a shared view of public health, the diversity of skills and backgrounds was viewed as an asset to joint working. Emerging relationships were generally perceived to be quite effective and expected to significantly improve though capacity issues and the frequency of organizational change appeared to make relationships more difficult to sustain. These issues needed to be recognized in developing and implementing policy, with further clarity needed as to which relationships are key for public health development and the costs and dividends of supporting these. Acknowledgements The authors would like to thank all those who participated in the study. Particular thanks go to those PCTs that agreed to host workshops and all those who invested considerable time to participate. Thanks also go to two anonymous reviewers. The study was funded by the Organisation and Management Committee of the former NHS Executive London Regional Office. The views expressed in the paper represent those of the authors and not necessarily those of the funding body.