چکیده (انگلیسی):

Background:Significant challenges exist within primary care services in the United Kingdom (UK). These include
meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological
services also struggle to meet waiting time targets and to ensure increased access to psychological therapies.
Innovative ways of delivering effective primary care and psychological services are needed to improve health
outcomes.
Summary:In this article we argue that integrated care models that incorporate behavioural health care are part of
the solution, which has seldom been argued in relation to UK primary care. Integrated care involves structural and
systemic changes to the delivery of services, including the co-location of multi-disciplinary primary care teams.
Evidence from models of integrated primary care in the United States of America (USA) and other higher-income
countries suggest that embedding continuity of care and collaborative practice within integrated care teams can
be effective in improving health outcomes. The Behavioural Health Consultant (BHC) role is integral to this, working
psychologically to support the team to improve collaborative working, and supporting patients to make changes to
improve their health across management of long-term conditions, prevention and mental wellbeing. Patients’
needs for higher-intensity interventions to enable changes in behaviour and self-management are, therefore, more
fully met within primary care. The role also increases accessibility of psychological services, delivers earlier
interventions and reduces stigma, since psychological staff are seen as part of the core primary care service.
Although the UK has trialled a range of approaches to integrated care, these fall short of the highest level of
integration. A single short pilot of integrated care in the UK showed positive results. Larger pilots with robust
evaluation, as well as research trials are required. There are clearly challenges in adopting such an approach,
especially for staff who must adapt to working more collaboratively with each other and patients. Strong leadership
is needed to assist in this, particularly to support organisations to adopt the shift in values and attitudes towards
collaborative working.
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* Correspondence:hannahdale@nhs.net
1
NHS Fife, Department of Psychology, Lynebank Hospital, Halbeath Road,
Dunfermline KY11 4UW, UK
2
School of Medicine, Medical and Biological Sciences Building, University of
St Andrews, North Haugh, St Andrews, Fife KY16 9TF, UK
© 2016 The Author(s).Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Dale and LeeBMC Family Practice (2016) 17:97
DOI 10.1186/s12875-016-0485-0
(Continued from previous page)
Conclusions:Integrated primary care services that embed behavioural health as part of a multi-disciplinary team
may be part of the solution to significant modern day health challenges. However, developing this model is
unlikely to be straight-forward given current primary care structures and ways of working. The discussion,
developed in this article, adds to our understanding of what the BHC role might consist off and how integrated
care may be supported by such behavioural health expertise. Further work is needed to develop this model in the
UK, and to evaluate its impact on health outcomes and health care utilisation, and test robustly through research
trials.