Historic differences across the clinical commissioning groups (which became NCL ICS) had resulted in substantial variation in service offers, with inconsistent waiting times and inequalities in outcomes across the ICS. For example, Islington had 5 times as many children’s community nursing staff as Barnet and was the only borough offering a hospital at home (virtual ward) service for seriously unwell children.

The core offer now defines the level of service residents can expect regardless of which borough they live in, covering NHS-funded services.

Work on the community services core offer, together with similar work on a mental health core offer and long-term conditions, provides a platform for NCL ICS to develop a neighbourhood health model that has chronic and complex populations at its heart, is proactive, preventative and tackles inequalities.

Key learnings

• The ICS started by mapping current services to the core offer and completing a gap analysis.
• Leaders across the ICS agreed that the level of variation needed addressing as a priority and launched a multi-year programme to create a core offer for all residents.
• The ICS co-designed the core offer with input from service users, carers, residents, clinicians, operational leads, GPs, local authority and voluntary, community and social enterprise (VCSE) partners.
• The ICS commissioned Carnall Farrar to help co-produce a set of priority services and care functions, as well as best identify how to coordinate across them (for example, through a central point of access and case management).
• The ICS agreed to several significant investments to harmonise community health services across the 5 boroughs, including:
  • the introduction of silver triage calls, which connect ambulance staff to senior clinicians with expertise in geriatric emergency medicine to support the assessment of older people
  • increased recruitment of healthcare professionals to a range of roles in attention deficit hyperactivity disorder (ADHD) services, community nursing and therapy services, thereby improving services’ capacity to deliver the core offer
  • investment in specialist and community eating disorder services to provide holistic assessment and co-production of care plans for children, young people and their families

Impact

NCL ICS reports the following benefits:

• due to work on the core offer, NCL ICB secured system commitment for an additional £55 millon for community health services over 5 years
• activity in years 1 and 2 is expected to generate savings of 66,000 occupied bed days (180 beds a year) by the end of 2024/25
• NCL has invested in scaling the use of Doc Abode. This NHS Innovation Accelerator-backed clinically-led company provides workforce scheduling software for urgent community response and hospital at home (virtual wards). In Central and North West London NHS Foundation Trust, Doc Abode doubled the average number of patient visits per shift from 2.9 to 6.4 visits, a 120% increase
• approximately 80% of silver triage calls have resulted in a frail or elderly person avoiding an unnecessary trip to hospital
• waiting times for eating disorder services have been reduced from 10 to 6 weeks

Publication reference: PRN01756_ii