Facilitators and barriers to delivering an optimal specialist service: an example from cleft lip and/or palate care

Despite published standards of care, inequities and variations in specialist care delivery in the UK have been identified. Using cleft lip and palate services as an example, this study aims to identify potential facilitators and common barriers to delivering an optimal specialist service. Individual interviews were conducted with 50 specialist clinicians, representing all 16 NHS cleft lip and palate services in the UK. Responses were analysed thematically. A range of barriers to optimal care were identified, including working within a restrictive medical model, declining resources and an insufficient evidence base. To facilitate optimal care delivery, participants described a need to share best practice, partner with academics to demonstrate service effectiveness, use technology in clinic and authentically integrate patient-centred care. Commissioners need to work more closely with specialist teams to ensure that resources are allocated based on need, with the view of optimising service delivery and patient outcomes.