Developing more joined-up health and care has been a bottom up, step-by-step journey for the NHS and its partners across the South East, building on the expertise of frontline staff and learning from what works well in different areas over a period of years. Now we want to take the next steps to put these voluntary partnerships on a statutory footing through the changes set out in the NHS Health and Care Bill.
In 2014, the NHS set out a widely supported vision for the future, describing the need for “triple integration” between hospitals and GPs, the NHS and social care, physical and mental health and kicked off vanguard projects around the country to trial ways of providing integrated care. One of these early vanguards was in the South East at North East Hampshire and Farnham set up to integrate hospital, community and mental health services. This became the Frimley Integrated Care System (ICS) in 2017 when 10 areas of England were selected to develop the first ICSs.
Of the 10 first wave ICS, a further three were from the South East region at Surrey Heartlands and at Berkshire West and Buckinghamshire which are both now part of the Buckinghamshire, Oxfordshire, and Berkshire ICS. Surrey Heartlands was one of just two places in the country (with the other in Manchester) to have a specific devolution agreement aimed at accelerating the integration of care.
Since 2017, ICS have been deepening the relationship between the NHS, local councils, and other important strategic partners such as the voluntary, community and social enterprise sector. They have developed better and more convenient services, invested in keeping people healthy and out of hospital and set shared priorities for the future including tackling health inequalities.
For example, some patients in the Nepalese community in South Reading, which is part of Berkshire West, were not taking up advice and education about diabetes resulting in poorer health. Working with the community, a programme was developed providing group consultations and education in Nepalese by a specialist Nepalese nurse. Patients who previously struggled with the service in English now able to identify and design what they need to help them take control of their health.
In 2019 the NHS Long Term Plan confirmed that all parts of England would be served by an integrated care system from April 2021, building on the lessons of the earliest systems. NHS England and NHS Improvement worked with local teams to develop a consistent approach to how systems would be designed, and the NHS Long-Term Plan set this out, highlighting three important levels at which decisions would be made:
- Neighbourhoods (populations circa 30,000 to 50,000 people) – served by groups of GP practices working with NHS community services, social care, and other providers to deliver more coordinated and proactive services, including through Primary Care Networks (PCN).
- Places (populations circa 250,000 to 500,000 people) – served by a set of health and care providers in a town or district, connecting PCN to broader services including those provided by local councils, community hospitals or voluntary organisations.
- Systems (populations circa 1 million to 3 million people) – in which the whole area’s health and care partners in different sectors come together to set strategic direction and to develop economies of scale.
Primary Care Networks
A fundamental aspect of ICSs are the PCN – GP practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services in their local areas in groups of practices. PCNs build on existing primary care services and enable more proactive, personalised, coordinated health and social care for people close to home. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and communities they serve.