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Table 4 Initial thematic analysis

From: Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory

Main theme Sub-themes Illustrative data
Recognizing the need for change GPs’ understanding of current services Theoretically we have access to counselling services. There is a group commissioned by the PCT called [names team] which I think has changed over the years from being a purely sort of counselling service to one with a range of psychological services” GP011
  Limited access to services “…psychological services as opposed to psychiatric acute services are dire locally, absolutely direwe have such limited access, theres just such a burden ofmild to moderate psychiatric illness and that isnt well catered for at all” GP001
  Reflections on the past The structure, I think, the way we used to work in the old days we used to work collaboratively anyway, which was really good, erm, but we havent got that structure now, so its about number crunching really, you know, in terms of referrals coming through to you, and being based ata main health centre where they have to come to you” CM102
Operationalising collaborative care Understanding collaborative care I was re-reading the protocol for this session (interview) and thinking, should I have been doing more with GPs? Talking with them more about medication? So I thought, maybe Ive done something kind of wrong and not quite completely as collaborative as I could have been, I think I probably couldve done more” CM106
  Delivering the intervention I didnt really understand collaborative care; Ill be quite honestI didnt know what collaborative care was, although I could have had a guess. Collaborative care would have meant care that involved both myself and someone else, if you see what I mean” GP004
  Its a better experience for the therapist, Ive kind of had a really positive experience of CADET, which I think if Id purely had experience of IAPT I wouldnt be feeling quite so positive about BA or telephone support or telephone supervision or whatever, so 100% I think its great” CM105
  Facilitating communication Something that is quite helpfulif a clients got an issue, especially something that is about medication I will say you know, “why dont you speak to your GP about that?” and I will sayI will be writing to your GP just to let him know that this is what weve discussed”, so the client would go, I would write a letter on the other side as well, and its quite nice because the client would then come back and goOh yeah, the GP got your letterand when I speak to the GP they sayOh yeah the client did come back to me after what you saidso I think, it really does work” CM104
   “…theres that sort of linking where the GP was linked in, and I think that he was really pleased that erm, he was actually able to have a conversation with me about the medication, because he was actually feeling stuck and I think [names CM] was feeling a bit stuck…” S102
  a lot of the time Ive also noticed that through the GP if you do mention that through supervision what I have been told is X, Y and Z, then they could be, you know, they could be more likely to listen as well, to accept your opinion, so yeah, I think that works quite well as well, if you do tell themafter discussing this in supervision, this is what we thought…” CM104
  Ive had very little, if any involvement with the study except notification from you that a particular patient has been included on the study” GP004
  Enhanced supervision I think sometimes Ill write to them asking them something or asking their opinion of something, then the GP will kind of contact me, get back to me, and I think on one or two occasions I have had a GP ringing just to ask if Id seen a client or when am I next seeing a client, so yeah, I think thats the only thing, itd not something that happens that often, one or two occasions” CM104
  Communication vs. collaboration Its such a big problem, Im not blaming anybody because GPs dont have the time.... You could try to make it happen, it would be nice just to see that, increasing that contactit sounds like a very desirable thing that would be helpful for everybodyI think collaborative is too strong a word for collaborative care, its not truly collaborative in my opinion, but thats my opinion” S105
Catering for complexity Recognition of complexity I dont think there is such a thing as pure depression, it comes in a package with lots of other things so when I say comorbid things, very often comorbid psychiatric problems, but also physical problems and never to forget, lots of social problems around, so youve got those three things there that are all competing, so there is a person with depression but at the same time there is obsessive compulsive disorder, or query, you know…” S104
  The need to avoid mind-body dualism I think that would be really helpful actually, for us to have more understanding of physical health problems and how they affect peoplewe need to recognize physical health problems and long term conditions and how they affect peopleI think knowledge about those is really important, we just need to know more” CM106
I would have thought logically yes, its likely to be those sorts of people, the more complex your problem the more likely you are to benefit from it, erm, yeah, I would say comorbidity, absolutely” GP015
Usefulness of a collaborative care approach for people with complex problems I think that the whole thing about collaborative care isnt about the interventions, its actually about the system, and so that case management role is greatyou know, I guess if youre saying, well theres the system which is about active follow up, is absolutely right and that covers all of these people” S101