Table 1 Barriers and facilitators to the collaborative care model

Co-location:

Lack of integration:

• Allows informal collaboration: ‘Last week there was a question that I had about somebody’s diabetes and the use of insulin… I actually just popped my head around the door for one of the practice nurses…just being there meant that I could ask her that.’ PWP01

• Lack of shared resources ; time for appointments not allocated by practice managers, limited access to practice information systems: ‘ ‘They’ve [nurses] got so many other things to factor into their appointments, they forget that I’m there.’ PWP05

• Destigmatises access to mental healthcare: ‘It’s based in the surgery…it’s not something strange and new and it works well, being in the same building, definitely, than going somewhere else.’ PN10

‘I feel quite blind by not having [access to] that [IT] system.’ PWP04

• GPs unaware of or uninvolved with the PWPs: ‘GP’s don’t even, I don’t think they know what the [IAPT] service does, never mind the role of the [PWP] practitioner.’ PWP02

‘GPs… they’re obviously not doing it themselves… They probably haven’t got time, but we haven’t either.’ PN11

Attitudinal Facilitators:

Attitudinal Barriers:

Perceived benefit of providing holistic care:

Role boundaries:

• Increased co-ordination and continuity of care: ‘Hopefully they’ll [patients] feel that there’s that continuous care kind of thing… they’ll see that it’s sort of a joined up kind of care and that they’re not just put onto another system, and that we’re still all talking to each other.’ PN01

• Clear division of mental and physical health work and expertise: ‘You’ve kind of got the mental bit which is me and then the physical which is the nurse…’cause I don’t want the patients thinking that I can help them…and it’s trying to be really clear that that’s not my role.’ PWP02

• Easier disposal route encourages detection: ‘Already I’m more enthusiastic about talking about [depression] and approaching it… because I feel I have something to give now… so instead of this skirting around the subject that I started off with, I feel I can go there now and talk about it quite happily’ PNO5

• Joint meetings perceived as unnecessary: ‘The nurse comes in just for the last fifteen minutes, otherwise she’d be bored rigid and she has better things to do than listen to me doing my bit.’ PWP02

• Lack of confidence to engage in the other area of work: ‘I feel that they [practice nurses] don’t have enough time to talk to people about their emotional wellbeing, and I think that they worry that if they start talking about it they’ll open Pandora’s Box.’ PWP05

‘I feel a lot more comfortable about doing it and because if people do say anything then I know that I have something I can do about it, can suggest something.’ PN08