Key messages

• frontline staff identified three main areas where barriers to integration persist: access to social services, interprofessional relationships and infrastructure
• difficulties contacting staff across sectors create delays in referrals and care coordination
• hostile working cultures and siloed practices contribute to poor collaboration between primary and social care
• overworked staff, inefficient multidisciplinary meetings and unclear responsibilities slow responses to patient needs
• lack of interoperable information systems, absence of pooled budgets and misaligned managerial incentives compound structural barriers.

Policy implications

• improving integration may require investment in interoperable information systems across sectors
• pooled budgets and aligned incentives could reduce structural divisions between primary and social care
• workforce strategies should address interprofessional relationships and organisational culture, not only processes
• clearer accountability arrangements may help reduce diffusion of responsibility in integrated working.

Gaps

• findings are based on London GP surgeries and may not reflect experiences in other regions
• perspectives of social care staff are not included
• limited insight into how barriers change over time or respond to policy interventions.

Commentary
This study highlights how workforce experiences shape the effectiveness of integration between primary and social care. Barriers are not limited to systems and structures, but are deeply influenced by relationships, culture and everyday working practices.

Difficulties in accessing social services and contacting staff across organisational boundaries delay referrals and disrupt continuity of care. From a care equity perspective, these delays may disproportionately affect people with complex needs who rely on coordinated support across sectors.

The findings also point to cultural and relational barriers. Hostile interprofessional relationships and siloed working undermine collaboration, while overwork and inefficient multidisciplinary meetings limit the capacity of staff to engage meaningfully in integrated care.

Structural issues, including non-interoperable information systems, lack of pooled budgets and misaligned incentives, further strengthen division between sectors. These barriers suggest that integration efforts focused solely on frontline practice are unlikely to succeed without also undertaking system-level reform.

Overall, the study shows that achieving equitable, integrated care requires attention to workforce conditions, organisational culture and infrastructure alongside policy and funding mechanisms. Without addressing these interconnected barriers, integration risks remaining aspirational rather than embedded in routine practice.