Agenda item

Lily O’ Connor (Programme Director Urgent and Emergency Care for Oxfordshire, BOB ICB) and Daniel Leveson (Oxfordshire Place Director, BOB ICB) have been invited to present a report with an update on Integrated Neighbourhood Teams in Oxfordshire.

There are TWO documents attached to this item:

1.    A cover sheet for the Integrated Neighbourhood Teams Report.

2.    The main report on Integrated Neighbourhood Teams.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Lily O’ Connor (Programme Director Urgent and Emergency Care for Oxfordshire, BOB ICB) and Daniel Leveson (Oxfordshire Place Director, BOB ICB) presented a report with an update on Integrated Neighbourhood Teams (INTs) in Oxfordshire. Also in attendance were Dr Bethan Willis (GP Lead for Inequalities, Banbury Cross Health Centre and Frailty GP For Banbury), Dr Sarah Lourenco (Clinical Director of Banbury Alliance PCN), Dr Suzanne Summers (Bicester Health Centre, Integrated Neighbourhood Team Bicester GP), and Dr Joe McManners (GP and OX3 Primary Care Network Clinical Director).

The Programme Director provided a comprehensive overview of the Integrated Neighbourhood Teams (INTs) initiative in Oxfordshire, which included GPs, social workers, community therapists, district nurses, and other healthcare professionals. These teams worked collaboratively to address unmet health needs, in areas of deprivation such as Banbury, Bicester, and OX3.

The Programme Director explained that while many aspects of the initiative might seem like they should already have been happening, the challenge in implementing them lay in the lack of additional workforce and funding necessary for providing the level of care required in these areas. The INTs aimed to provide that additional funding and staffing, particularly in areas of unmet health needs.

The Chair thanked the Programme Director for her summary and opened the floor to questions from the Committee.

Question on reducing health inequalities and continuity of care:

The Committee asked for elaboration on how the existence and functions of INTs would help to tackle and reduce inequalities in Oxfordshire and deliver continuity of care, and whether this would be delivered in rural areas. The Programme Director responded that continuity of care was a fundamental component of INTs. The initiative ensured oversight and coordination across multiple healthcare professionals, which was crucial for patients who preferred to interact with a single trusted individual. This approach not only benefited patients but also enhanced job satisfaction among healthcare professionals due to the continuous relationship with the same patient group.

Regarding rural areas, the Programme Director acknowledged the challenges and explained the phased approach to expanding INTs. Currently, the focus was on areas with the highest unmet health needs due to limited funding, but there were plans to extend the initiative to other areas, including rural areas, if more resources became available. The Oxfordshire Place Director emphasised that in Oxfordshire they had chosen to prioritise supporting the development of integrated neighbourhoods through the Better Care Fund and it was a central part of their primary care strategy.

Question on fragmentation of services and focus on specific conditions:

The Committee enquired about the focus on different conditions in different localities.

The Programme Director clarified that the INTs were designed to address the specific health needs of each local population, which was why the focus areas differed. The initiative was not limited to single conditions but took a holistic approach to managing the overall health of the population. The emphasis on different conditions in various areas was based on thorough background work and population-health data, ensuring that the INTs addressed the most pressing health issues in each community. A GP from an OX3 INT provided a practical example to illustrate the concept of integrated care. He described a case involving a terminally ill patient with advanced cancer who preferred to stay at home. The coordinated effort between the hospital teams, care teams, and district nurses ensured the patient received comprehensive care at home. Dr McManners emphasised that this level of integration was essential for managing complex cases effectively and providing patients with the best possible care.

Question on Oxfordshire County Council’s involvement in INTs:

The Committee enquired about the extent of Oxfordshire County Council’s involvement in both the development as well as the services provided by INTs. A GP from a Bicester INT reported that they participated in pilot sites and collaborated closely with Oxfordshire County Council. Their work primarily focused on weekly multidisciplinary team meetings. These sessions involved the hospital's care team, responsible for discharge planning, and the County Council's social work team. The goal was to track patients' status and care needs, ensuring timely support.

The Director for Public Health added that Public Health had developed ten community profiles in Oxfordshire’s most deprived areas, which highlighted some of the tailored needs in those communities and linked directly with the work done by INTs.

Question on the extent of coproduction and management of INTs:

The Committee asked whether coproduction was at the heart of the design and the development of INTs, and what definition of coproduction they were using. The Programme Director acknowledged that while there had been efforts to engage with public groups, the level of coproduction needed more depth. Going directly to the communities and understanding their specific needs was crucial as a granular level of detail was necessary for making impactful changes.

Regarding the management of these teams, the Programme Director explained that the integrated team setup required more than just additional sessions by GPs. It also required the involvement of care coordinators, voluntary sector social prescribers, and non-clinicians who focused on the person rather than the condition. This bottom-up approach ensured that the design of each INT was based on the experiences and needs of the local community.

Question on challenges related to information sharing, funding, and measuring outcomes:

The Programme Director detailed the complexities of information sharing and highlighted the need for agreements within GP surgeries and PCNs to ensure safe and effective data sharing. The challenges posed by different healthcare systems used by primary care, community services, and secondary care were noted. Efforts were ongoing to integrate these systems, though significant risks remained.

Regarding funding, the Programme Director explained that the true cost of INTs was still being assessed with the help of health economists from Oxford University. They were measuring the impact of INTs by comparing data from INT patients with control groups to determine the cost-effectiveness and benefits of the initiative.

Question on public awareness and understanding of INTs:

The Committee enquired as to the extent to which the public were aware of and understood what INTs were and how they operated. The Programme Director recognised the complexity of the initiative and the need for public education. Plans were in place to engage with local community groups and educate the public about the benefits and operations of INTs. This ongoing engagement would help ensure that residents understand the new approach to coordinating health needs.

The Committee AGREED to issue the following recommendations to Oxford University Hospitals NHS Foundation Trust:

1.    That there are clear governance and management processes around both the development as well as the activities of Integrated Neighbourhood Teams. It is recommended that there is clear transparency around this.

2.    To ensure ongoing coproduction with neighbourhoods and key stakeholders around the formation as well as the activities of Integrated Neighbourhood Teams. It is also recommended that an agreed definition of coproduction is outlined by system partners in this regard.

3.    To develop a clear understanding of the health needs and population patterns for each locality, and to allocate resources for Integrated Neighbourhood Teams accordingly.