The Nottingham City Integrated Care Partnership (ICP) has been running since June 2019 but what has it achieved so far and what role does it play in the city's voluntary and community sector?
Through a series of articles, we’ll be providing an overview of Nottingham City ICP and its current priorities, as well as exploring the role we, at Nottingham Community and Voluntary Service (NCVS) play as a partner organisation, and how the voluntary and community sector can become more involved in the ICP to help shape and develop it.
Article 1: An Introduction to Nottingham City Integrated Care Partnership (ICP) and its priorities
The Nottingham City ICP was established in June 2019 and covers the same population area as Nottingham City Council, which is around 340,000 people. Nottingham City ICP was set up to bring together health and care providers and local commissioners to work together to improve services for the city’s population and to make sure that they are meeting people’s needs, particularly in relation to addressing health inequalities. This includes taking into account wider determinants on population health such as socio-economic factors, people's physical environment, their health behaviours, and the health care options available to them.
It's important to note that the ICP is not just an NHS-led partnership but instead, is built around organisations working across a wide range of different sectors including primary care, urgent and emergency care, community care, social care, mental health and voluntary services.
The current partners of the Nottingham City ICP are:
- Nottingham City Care Partnership
- Nottingham City Council
- Nottingham City Homes
- Framework Housing Association
- Nottingham City General Practice Alliance
- Nottingham Community and Voluntary Service (NCVS)
- Healthwatch Nottingham and Nottinghamshire
- Nottinghamshire Healthcare NHS Foundation Trust
- Nottingham University Hospitals NHS Trust
- Nottingham and Nottinghamshire Clinical Commissioning Group
It is only by working collaboratively with all these organisations that the ICP is able to better understand and tackle the different health needs of Nottingham’s diverse communities.
The role of Primary Care Networks (PCNs)
A core part of the ICP are the eight Primary Care Networks (PCNs), which were established across Nottingham City in July 2019.
While the ICP covers the city, PCNs work at a more local level, based around neighbourhoods in the city. They started as General Practices collaborating together, but are maturing to work across a wide range of areas which all play a part in supporting people’s health and wellbeing, including:
- Community health
- Mental health
- Housing
- Social care
- The voluntary sector
- Other neighbourhood services
A key focus of the PCNs is around helping residents to look after their health and wellbeing. The idea is that by intervening at an earlier stage and equipping residents with the skills to manage and improve their health, there will be less likelihood of them needing more intensive support.
Nottingham City ICP's priorities
When establishing an initial set of priorities, the ICP worked with over 35 organisations in the NHS, social care and voluntary sector to explore key themes and understand what really matters to residents in relation to their health and wellbeing.
The ICP also used a huge amount of data, including Census and public health information, to build a full picture of people’s health in Nottingham.
NCVS and Healthwatch played a key role in supporting this work by connecting community groups and voluntary organisations with the ICP at a partnership event, held in January 2020. This, along with the other information gathered, resulted in a series of key messages reflecting what matters to local people which went on to form the foundation of the ICP’s priorities.
These were:
- Understand me and listen – “If I found the time to go to see the GP, he wouldn’t understand me and I wouldn’t understand him so what’s the point?”
- One size doesn’t fit all – “You cannot slice a person up to fit services!”
- Think about the family – “My mum and dad are out all day and they don’t have time to cook so we mostly eat takeaways.”
- Health is not my first priority – “Health is the last thing I think about. I am trying to keep a roof over my head, feed my family and get a job.”
- Accessing services is difficult – “They treat illness with drugs but forget about everything else. I have no access to mental and wellbeing services or physiotherapy.”
- Accessing services is expensive – “I can’t afford the bus fare to get across the city for an appointment.”
- There are reasons that I won’t access services – “I don’t trust services as they do not understand my culture and religion.”
- My culture and religion are important – “I can’t talk to my parents about this because you can’t talk about this issue in my community.”
- Give me information I can understand – “English is not our first language so we don’t like talking to others and are conscious that we don’t understand the system.”
In March (2021), NCVS and Healthwatch hosted an online event to feedback to voluntary and community sector partners who had been involved in exploring the initial themes. Rich Brady, Programme Director for Nottingham City ICP summarised what has been achieved so far.
What follows is a look at each priority in turn and the work that has been done to address it.
Supporting people who face multiple disadvantages to live longer and healthier lives
Since the beginning of the pandemic, ICP partners have worked to provide wraparound support to rough sleepers. This has involved supporting over 70 people, many of whom have been entrenched in rough sleeping for a number of years, into long term accommodation. Following the government’s ‘Everyone In’ initiative which saw rough sleepers supported with hotel accommodation, partners came together to provide wraparound support including running twice-weekly substance misuse harm reduction clinics, weekly mental health assessment clinics and Blood Borne Viruses (BBV) and Sexually Transmitted Infection (STI) screening and treatment clinics.
Wraparound support brings together services including substance misuse, housing, primary care, community health, mental health and others to coordinate and provide support to people who sleep rough or are a risk of rough sleeping. ICP partners have established a multidisciplinary team (MDT), to continue delivering this wraparound support model.
Weekly strategic meetings are currently taking place to address how the health and local authority commissioners can take a different approach to commissioning in regards to funding rough sleeping services. The question being addressed is, ‘how do we get the providers in a room with the people who know rough sleepers best, in order to design services that will truly work to support their needs?’
This strategic work was initially focused on rough sleepers, but the ICP has now established six workstreams which will see the programme expand its reach to meet the needs of more people who face Severe Multiple Disadvantage.
Preparing children and young people to leave care and live independently
The ICP recognises that it can be difficult for young people leaving care to gain access to ongoing support. ICP partners have identified three initial areas of focus for improved outcomes:
- Mental health - make it easier for children and young people who use mental health service to continue to use them when they become an adult
- Accommodation – bridge the gap between residential or foster care and the adult world
- Positive destinations - support young people to be independent and gain skills and experience that prepare them for leaving care
The ICP has partnered with Barnado’s, the children’s charity, to provide support to 10 care leavers with their preparation to leave care being provided through a supported lodging scheme so, they are better equipped for living alone as a young adult. They are also working with Barnardo’s to explore the implementation of a ‘Gap Homes’ model. ‘Gap Homes’ is a model of supported accommodation for care leavers with a focus on young people aged 16 or over, who have been assessed as not being ready for their own tenancy.
Supporting those who smoke to quit and reducing the number of people at risk of smoking
Service providers and commissioners have been coming together on a regular basis since the summer of 2020 to understand how to make better use of the collective resource in the city to support people to stop smoking, targeted campaigns, focused around key national events such as Stoptober and National Non-Smoking Day, have played a key part in this. During October 2020, Nottingham saw a 50 per cent increase in the number of people taking up support to quit smoking, with the ICP playing an influential role in increasing the capacity to meet that demand.
Increasing the number of people receiving flu vaccinations
The ICP has increased uptake of the flu vaccine in all targeted cohorts including school-aged children (4 to 11), pregnant women and people under the age of 65 who are known to have respiratory conditions, such as asthma. These are all cohorts where uptake has been historically low. Among neighbouring core cities, Nottingham was the only one of this group to see an increase in the number of pregnant women receiving the flu vaccine.
The ICP has also worked with Nottingham Council of Mosques and the British Islamic Medical Association (BIMA) to increase uptake amongst faith communities. As a result, two faith schools in Nottingham, who have previously not engaged in the school immunisation programme, have come on board.
Reducing inequalities in health outcomes in Black, Asian and Minority Ethnic (BAME) Communities
The ICP is undertaking a review of commissioning processes to address structural racism, as well as working to strengthen overall engagement and involvement with Nottingham’s BAME communities. This has involved working with Nottingham’s voluntary and community sector to better understand the contributions of VCS organisations in the commissioning of services in order to more fully meet the health and wellbeing needs of BAME communities.
During the pandemic, work has been done to understand, listen to and address vaccine hesitancy amongst residents. This has included improving access to the vaccination for some faith communities by setting up a number of pop-up vaccination sites at two of the city’s mosques, where appointments continue to be fully booked.
More information on the ICP’s role in the Covid-19 vaccination roll-out
The ICP has brought together key partners that have a role to play in supporting the uptake of the coronavirus vaccine to form the City ICP Covid Vaccination Co-Ordination Group. The group has been working to identify the cause of vaccine hesitancy among residents, as well as supporting information sharing between partners and working with the Local Resilience Forum (LRF) to support with finding suitable vaccine site locations/reaching areas of low vaccine uptake. The group is also developing a plan to ensure vaccination myths are dispelled in a collaborative way, and that there is one voice to increase vaccine uptake across the city.
Developing the ICP and establishing the ICP culture
The ICP is currently undertaking a formal review of its programmes and the progress made over the past year, and will use feedback gathered from its partners and the VCS to set its next set of priorities for 2021/22.
The Nottingham City ICP also plans to:
- Accelerate the development of the Primary Care Networks to better integrate support, building multidisciplinary teams to support people’s needs
- Expand the reach of the partnership
- Continue to build the ICP in partnership with Mid and South Nottinghamshire ICPs and the Nottingham and Nottinghamshire Integrated Care System
As part of this work, the ICP has launched a co-mentoring scheme for staff working across the partnership. The programme, set up in December 2020, is aimed at all staff who are interested in developing their understanding of what it is like to work in different roles and in different organisations. 16 colleagues attended the first session and have been paired into 8 co-mentoring partnerships. Co-mentoring partnerships are made up of colleagues working in a variety of different roles from across the partnership. Colleagues are meeting regularly and will participate in a formal evaluation in March 2021.
Throughout 2021, ICP partners are running a series of ‘share and learn’ webinars which give the opportunity for ICP and ICS colleagues to find out more about the ICP, its partners and programmes of work. Each session is 30 minutes, with presentations from partners followed by question and answer sessions.
If you would like to find out more about any of the ICP programmes or any opportunities to be involved, please contact rich.brady@nhs.net
