This page aims to answer some of the commonly asked questions about the Central Lancashire integrated care partnership.
An integrated care partnership (ICP) is a formal partnership of organisations (commissioners and providers) working together to improve the health and care of the whole population they serve. These are at sub Lancashire and South Cumbria level, i.e. Central Lancashire, Fylde Coast, Pennine Lancashire, West Lancashire, Morecambe Bay.
When this concept was first introduced, it was described as an accountable care partnership. More recently, the term integrated care has been used as it is a better description of what we are doing differently. This was formalised within NHS England’s planning guidance, published in February 2018, which included the announcement of the term ‘integrated care’ and has been consistently used ever since in national strategic publications such as the Five Year Forward View next steps and recent Long-Term Plan.
Artificial barriers exist between professionals and services. Patients, staff and organisations all feel these barriers at different levels, for example having multiple appointments with multiple different services provided or commissioned by different organisations. This makes the system confusing for patients and also frustrating for staff. Whilst we can try to, as much as possible, streamline our pathways and processes there some things which we simply cannot do because of the regulation and necessary governance requirements in place upon our organisations and services.
There is no single model for how our partnership should be arranged – it is up to us to determine the best approach to ensure the best health and care for our population. While we have a clear vision of what we want to achieve, we need to build on what works well here and elsewhere to find the right approach for integrated health and care.
Staff will increasingly work more closely with colleagues from other organisations. This should give health and care professionals more time to spend with people who need their help by reducing unnecessary duplication. Improved data sharing and technology will support staff in their roles. New ways of working will create new and flexible roles with development opportunities for staff.
We have formed a senior leadership team from existing executive officers within the partner organisations and are developing a shared approach to programme management to monitor progress.
Overall responsibility for monitoring of this progress lies with the Shadow ICP Board which has been in place since April 2018. This board is supported by an independent chair and ICP Programme Director. This board consists of senior colleagues from the boards and governing bodies of partner NHS and local authority organisations. Members leave behind their organisational allegiances to take a Central Lancashire-wide population view, at all times putting the best interests of local people first.
Shadow form means we are working towards being a full partnership. Organisations that are part of the ICP will work together to use health and care resources in the best way possible. However these individual organisations will remain accountable in their own right each with their own board or governing body. Benefits of being in shadow form include more freedom to make commissioning decisions, support from NHS England and NHS Improvement and additional funding to support these improvements.
We will be building the partnership through a number of phases over the next few years. Unlike other NHS changes, the emphasis here is on finding local solutions that meet our particular communities and requirements – rather than implementing a top down restructure. This means that we are working without any strict guidelines or requirements and the creation of a full partnership will be at our design and pace. We are also working within the current legislative framework – although there are proposals within the Long Term Plan to review parts of current legislation, there is no indication of when any changes may take place. However, we want to move quickly and see progress towards a full partnership which includes integrated decision making, budgets, governance, workforce etc, within the next three years. An annual ICP Plan will set out what milestones we will expect to achieve towards this within that year.
Along with the commissioners and trusts, local authority partners (from Lancashire County Council) are part of the senior leadership team and ICP Board which oversees the partnership plans and decisions. Elected Members are represented on the ICP Board via Councillor Shaun Turner. District Councils have one representative, the Chief Executive Officer of Chorley Council who links into other officers and members via the Central Lancashire Health and Wellbeing Partnership.
GPs and practices are already working together to improve the way in which services are delivered. There are eight networks across Central Lancashire (networks are clusters of GP practices, working alongside community services within a geographical area, covering populations of typically between 30,000 and 50,000 patients). A primary care organisation which spans across all practices within Central Lancashire is emerging and we expect in the future that this will be the vehicle by which the CCGs will contract for services delivered to populations larger than a single network/neighbourhood, for example all of Chorley and South Ribble or both Greater Preston, Chorley and South Ribble. This organisation will then represent primary care on the ICP board and could potentially hold a delegated budget responsibility for all community and primary care services.
At present practices are struggling to meet high demand. This means GPs and other primary care staff do not have the time to spend with their patients to help them better manage their health. Greater integrated working means that GPs and primary care staff are part of a wider community support network which makes best use of all resources available, including those in the voluntary, community and third sector. This will help patients to stay well, manage their conditions when they do become ill, use services appropriately when they need to and free up GP time for those patients with more complex needs.
The individual organisations which make up the partnership will still be accountable in their own right. Any provider contracts which are commissioned either jointly between the CCGs, local authority or by Healthier Lancashire and South Cumbria will still be required to fulfil the requirements of the standard NHS contract. Commissioned services will be subject to the same level of scrutiny as they currently are. In addition, we’re continuing to work with NHS England and NHS Improvement to develop governance and accountability arrangements so it is clear how decisions are made and who is accountable.
There is no reduction to the funding we have available to spend on healthcare services locally, so this is not about saving money.
We are all living longer and often with more long-term complex conditions as a result, meaning we require a greater input from health and care services for a longer period of time. It is nobody’s fault but this inevitably creates extra demand on services and the limited financial resources available.
This demand is rising faster than our budgets are increasing, and so we are facing a funding gap. In order to provide the best health and care system for people living within Central Lancashire then we need to make the best use of the combined resources available to us. That means considering what is best for the whole Central Lancashire population and healthcare system rather than individual parts. We can achieve this by better working together to improve quality and reduce duplication. We are all responsible for ensuring we make the best use of the resources available to us.
An integrated workforce is one that works more collaboratively so that the whole team supporting patients are aware of their needs meaning that the right professional can provide the right support at the right time.
For example, network teams which are starting to operate across the area are made up of professionals from across different organisations and services. GPs and practice staff work alongside community nurses, therapists and wellbeing workers who are all employed by the trusts as well as social workers who are employed by the council. Working together as one team, the professionals put aside their organisational allegiances to make sure that their skills and expertise are used appropriately to meet all of the needs of the patients they care for.
It might mean sharing data where appropriate, and making better use of technology. We anticipate there will be opportunities for staff through new roles and ways of working.
There
are lots of potential benefits for staff within this partnership. More
joined-up working with colleagues in other organisations means staff will not
be duplicating or repeating work and will have access to more information about
patients where this is necessary. This will give staff more time to spend with
patients and a better understanding of their needs and how they can be
supported. There will also be new roles and development opportunities for staff.
For patients, they will be able to receive the support they need closer to home in a community setting. This includes support to best manage their own health and wellbeing. Patient choice will not be affected. Patients will still have a legal right to choose from a range of locally commissioned services.
This
is not about privatising the NHS. It’s about health and social care
organisations working more effectively together to make best use of collective
resources to benefit our local population.
At the moment, the ICP partners include the statutory NHS and social care organisations collaborating more formally. Overtime it is likely that we will work more closely with other health and care organisations too, such as out-of-hours or care home providers, for example.