Table 4.

Initial thematic analysis

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 dire…we have such limited access, there’s just such a burden of …mild to moderate psychiatric illness and that isn’t 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 haven’t got that structure now, so it’s about number crunching really, you know, in terms of referrals coming through to you, and being based at… a 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 I’ve done something kind of wrong and not quite completely as collaborative as I could have been, I think I probably could’ve done more” CM106
	Delivering the intervention	“I didn’t really understand collaborative care; I’ll be quite honest… I didn’t 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
		“It’s a better experience for the therapist, I’ve kind of had a really positive experience of CADET, which I think if I’d purely had experience of IAPT I wouldn’t be feeling quite so positive about BA or telephone support or telephone supervision or whatever, so 100% I think it’s great” CM105
	Facilitating communication	“Something that is quite helpful… if a client’s got an issue, especially something that is about medication I will say you know, “why don’t you speak to your GP about that?” and I will say “ I will be writing to your GP just to let him know that this is what we’ve discussed”, so the client would go, I would write a letter on the other side as well, and it’s quite nice because the client would then come back and go “Oh yeah, the GP got your letter” and when I speak to the GP they say “Oh yeah the client did come back to me after what you said” so I think, it really does work” CM104
		“…there’s 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 I’ve 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 them ‘after discussing this in supervision, this is what we thought…” CM104
		“I’ve 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 I’ll 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 I’d seen a client or when am I next seeing a client, so yeah, I think that’s the only thing, it’d not something that happens that often, one or two occasions” CM104
	Communication vs. collaboration	“It’s such a big problem, I’m not blaming anybody because GPs don’t have the time.... You could try to make it happen, it would be nice just to see that, increasing that contact… it sounds like a very desirable thing that would be helpful for everybody…I think collaborative is too strong a word for collaborative care, it’s not truly collaborative in my opinion, but that’s my opinion” S105
Catering for complexity	Recognition of complexity	“I don’t 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 you’ve 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 people… we need to recognize physical health problems and long term conditions and how they affect people…I think knowledge about those is really important, we just need to know more” CM106
		“I would have thought logically yes, it’s 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 isn’t about the interventions, it’s actually about the system, and so that case management role is great… you know, I guess if you’re saying, well there’s the system which is about active follow up, is absolutely right and that covers all of these people” S101