This summary introduces a main paper of the same name in the Health Matters Library available online   https://www.healthmatters.org.uk/Library/coip_0322.pdf  

 The main paper, Developing Community-Oriented Integrated Practice (COIP), explains how COIP:

2  Is important because it provides a set of theories and methods to reconcile dynamic-creative and controlling-compartmentalising ways of thinking. Complex responsive thinking (needed for spiritual, educational and community-building actions) finds its place alongside reductionist thinking (needed to diagnose and treat diseases). This helps people to appropriately combine thinking about whole systems, complexity and co-evolution, with thinking about direct control. It helps to integrate quantitative and qualitative approaches to research, individual and population approaches to health improvement, and capitalist and socialist approaches to politics.

3  Energises people to work for the good of whole populations as well as self-interest. It does this through cycles of collective learning and coordinated change that bind people together, fuelled by modest multidisciplinary projects that help participants to listen sensitively and appreciate ‘other’. 

Context. Community-Oriented Integrated Practice (COIP) enables integration of different efforts. This is needed for health promotion and care; and also to effectively address many ‘big picture’ or complex issues – pandemic response, environmental degradation, racism, violence…..  As well as improving objective outcomes, COIP builds communities and improves action competence and social cohesion - so people are ready, willing and able to improve the health of whole populations, beyond personal interest. 

Integration in COIP is less ‘hard-wired’, linear connection and more alignment of ways of operating, with methods that help people from different parts of different systems to step out of their ‘silos’ to co-create locally-relevant innovation.

Methods. The main paper describes learning from the London borough of Ealing implementation of policy for COIP (2007-2019) that improved markers of diabetes care, Liverpool Primary Care Facilitation Project (1989-1995) that developed multidisciplinary, systems-thinking practices, the West London Research Network (1997-2001) that engaged a quarter of all West London general practices in research, and a ten-year conversation with case studies published in the London Journal of Primary Care (2008-2018).[Articles available at: https://www.ncbi.nlm.nih.gov/pmc/journals/2028/     and https://www.tandfonline.com/  PubMed courtesy of Taylor & Francis]

Findings. The main paper, available at https://www.healthmatters.org.uk/Library/coip_0322.pdf ,argues the logic and benefits of the COIP approach, supported by 88 references that reveal the background schools of thought, including Fourth Generation Evaluation (Local Reflection on Quantitative and Qualitative Data) and Identity-Formation, especially how people’s sense of ‘I’ and ‘We’ are inter-related and co-created through dynamic interaction in the world. These ideas can be strategically used to systematically build compassionate communities. 

Conclusions. The COIP approach can be used, at scale, in different contexts and at different speeds. The main paper in the Health Matters library describes five inter-connected policies to develop COIP: 

1) Build structures to support whole system learning and change. 

2) Facilitate local engagement in local developments. 

3) Develop case studies. 

4) Empower the learning of theory and practice of integration. 

5) Support multidisciplinary leadership teams. 

It also describes four aspects of a curriculum for COIP, each with a Box for further reading: 

1.    Primary Care as a lead for community-oriented integrated practice [Box1]

2.    Reality as an organic, living system – a complex adaptive system [Box2]

3.    Health as positive narrative unity - overcoming difficulties with a smile [Box3]

4.    Leaders as Sense-Makers – facilitating co-evolution of forests and trees [Box4] 

Key Words: Whole System Integration. Community-Oriented Integrated Practice. Primary Care Networks. Integrated Care. Comprehensive Primary Health Care.

Authors:

2  Laura Calamos, PhD, MSN, RN, FNP-BC, FHEA. Family Nurse Practitioner. COIN Co-Chair (Community-Oriented Integration Network). Email: lauracalamos@outlook.com. 

3  Raj Chandok. FRCGP, FRCP, FRSA, MSc. GP Principal, Dr G Singh & Partners. Vice-Chair & Diabetes Strategy Lead NHS Ealing CCG 2012 -2020. Email: rajchandok@nhs.net