The Complete Care Community Programme: Supporting PCNs to narrow health inequalities in their local area

Health inequalities in England have increased in recent years and many continue to do so, a fact brought into sharp focus by the COVID-19 pandemic. The Complete Care Community Programme was established to support Primary Care Networks in designing proven, scalable solutions to tackling local health inequalities.

Bringing together the transformation expertise of Arden & GEM’s Healthcare Solutions team with the clinical leadership experience of Healthworks, this national programme provides practical help to sites in adopting systematic approaches, overcoming barriers and sharing their learning with others.

The challenge

Health inequalities are the observable difference in health experience and outcomes between different groups of people which arise from the unequal distribution of social, environmental and economic conditions within societies. Health inequalities in England have increased in recent years and many continue to do so, a fact brought into sharp focus by the COVID-19 pandemic. Progress in identifying and narrowing health inequalities has been variable, with local initiatives often encountering challenges in sustainability and wider adoption.

Primary care has long worked at the heart of the community, building an understanding of local problems and developing productive relationships with other local services. The advent of Primary Care Networks (PCNs) – combining the local knowledge of GP practices with the scale to resource projects – offered a new opportunity to address health inequalities for defined population segments. To improve upon past initiatives, and design solutions which would be proven and scalable, a new framework was needed which would provide practical help to sites in overcoming barriers and sharing their learning with others.

Our approach

The Complete Care Community (CCC) Programme brings together the expertise of Arden & GEM’s Healthcare Solutions team with Healthworks, under the clinical leadership of Professor James Kingsland OBE and with funding from the National Healthcare Inequalities Improvement Programme at NHS England.

The programme centres on working with PCNs to identify the key health inequality challenges faced by their local populations, in particular those associated with the wider determinants of health that require collaborative working with local councils and other agencies. The programme aims to:

• Encourage sites to collaborate and share learning
• Identify the ‘enablers’ and ‘barriers’ to addressing health inequalities
• Collate case studies that demonstrate how health inequalities may be reduced
• Establish a process to adopt successful approaches to narrowing health inequalities across England
• Evaluate the success of local projects.

The first phase of the programme, which launched in 2020, saw 20 PCN demonstrator sites selected, covering three NHS regions. Sites are able to access mentoring, coaching and programme management to support delivery of a project to narrow health inequalities in their local area, while also being brought together as part of a network to share learning.

Programme support
Once sites have been onboarded to CCC through Healthworks, the CSU’s programme management team hold an introductory meeting to establish key information and requirements. This is followed by monthly meetings and the submission of regular highlight reports to demonstrate site progress.

A monthly programme-wide report, by region, is produced to keep NHS England informed, with all highlight reports, meeting outputs and contact information hosted on a dedicated SharePoint site. Where further support is needed, this is facilitated through Healthworks’ portfolio of specialist consultants and through the CSU’s wider multidisciplinary team, including data expertise and clinical systems support.

Bringing sites together
A regular monthly meeting brings together clinical leaders, PCN/practice managers and social prescribers to share progress, challenges and learning. The sessions create a community of practice which discusses common themes to provide peer support and help transfer knowledge.

Additional quarterly plenary sessions are led by Arden & GEM focusing on specific pre-agreed topics of interest with invited expert speakers. These sessions are complemented by quarterly action learning sets which are smaller facilitated informal gatherings on common themes, challenges and service areas such as mental health, and children and families.

This combination of larger formal meetings and smaller informal sessions creates the space to network and share experiences but within a structure that captures learning and outputs in a more systematic way.

Early evaluation
An early independent evaluation, by the University of Central Lancashire and based on an ‘action research’ methodology, utilising semi-structured interviews and questionnaires, has found:

• A sound level of engagement and support in all the sites
• A correlation between successful progress and engagement with the non-NHS sector
• An inverse correlation between project progress and feelings about workload.

These findings will be combined with a literature review to highlight the general principles in creating a sustainable environment to allow sites to flourish.

The outcomes

CCC has given sites the framework, support and community of practice to successfully implement locally-driven solutions to health inequalities through a diverse range of projects including:

• Helping to meet the health needs of people experiencing homelessness on the South Coast through a dedicated Health Bus
• Tackling Newham Central’s high level of knife crime incidents through targeting at risk young people via collaboration with West Ham Football Club and Youth Link Workers.

The second phase of the programme has now launched, extending CCC to 46 sites, and looks to establish the most successful methods of cross-sectoral collaboration which will be a focus of the next stage of the evaluation.