Talking about alcohol: communities of practice and patient pathways

It is widely argued in policy circles and academic research that the health and social care needs of people with multiple and complex needs are greatly enhanced through a shared commitment to inter-professional practice and transformational learning. We take this assumption to task by examining a ‘community of practice’ (a working group for high-impact users facilitated by a large inner-city GP surgery), which brings together frontline practitioners and statutory commissioners working at the interface between homelessness, health and substance use. We then go on to identify four areas: (1) knowledge exchange and critical reflection; (2) networks of intervention; (3) inequality in relations and resources and (4) competition and congruence – that demand critical attention if we are to understand more fully the potential role of ‘communities of practice’ in acting as bridgeheads to health and social care integration.