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Policy Research Programme - Complete Care Community Programme

Published

10 May 2022

Version

1.0 - May 2022

Contents

Timetable and Budget

Description

Deadline/Limit

Deadline for Stage 1 Applications

14 June 2022, 1 PM

Notification of outcome of Stage 1 Application

August 2022

Deadline for Stage 2 application

28 September 2022, 1 PM

Notification of outcome of Stage 2 Application

January 2023

Project Start

February 2023

Budget

Up to a maximum of £1 M total budget, across multiple phases (including initial mobilisation / feasibility testing)

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme invites proposals for a single research project on the Complete Care Community Programme (CCCP).

This project should provide evidence as to how the CCCP is being implemented across different sites nationally. This will include an initial assessment of impacts and outcomes - covering, for example, issues related to experience of local people and the workforce. access to care, health inequalities / disparities, and efficiency / value for money. This is a significant opportunity to inform delivery in a key area of health policy.

Background

The CCCP was launched in April 2021. Funded by NHS England and Improvement (NHS E&I), the CCCP is a national programme designed to help address health inequalities in England. The Programme takes a population health management approach to health and care delivery, and involves a wide range of demonstrator sites that are focused on addressing health and care needs in their local areas (including those related to the wider determinants of health).

Each site is made up of host Primary Care Networks (PCNs) and local system partners (including statutory and non-statutory bodies), which are required to work together collaboratively to target local health priorities through locally agreed interventions. This includes the development of new provider teams of combined health and care professionals, along with other community-based services.

Demonstrator sites within the CCCP address a wide range of population health and complex care issues: they target different sections of their local community, in locally tailored ways, and focus on long-term improvements in health outcomes. The CCCP sites are led by different partners within each local health economy and work in different ways to meet local need and harness local innovation. However, across all sites, a broadly consistent approach to service integration, cross-sectoral collaboration and multidisciplinary team working is being adopted. Taken as a whole, demonstrator sites cover a suite of interventions and approaches to delivering personalised care and services to individuals, groups, and the wider population.

The need for research

The commissioned research should provide an objective assessment of the CCCP, capture learning across the range of local models, identify positive learning of wider applicability, and establish approaches to tackling barriers and obstacles. This study will need to complement and substantially extend other strands of evaluation, including work by the CCCP Programme Management Office (PMO).

It is important that this project generates generalisable learning as to ‘what works’ in terms of effective implementation, achieving impacts, and improving outcomes across diverse sites. This should contribute to better understanding of how cross-sectoral partnerships work best to deliver place-based care, relevant to Integrated Care Systems (ICS) and Sustainability and Transformation Partnerships (STPs).

A key interest for national policy makers is for results from the evaluation to be translated into practical evidence-based approaches, and to identify factors that may facilitate their potential adoption at scale. This study provides a significant opportunity to inform national policy, as well as local delivery, on different approaches to addressing health inequalities.

We envisage a programme-wide study, composed of different work packages, and suggest applicants set out a mixed methods and multi-phased approach for delivering this evaluation. Key objectives for this evaluation include the following - to:

  • Assess the effectiveness of integrated care and cross-sectoral working across local systems within the CCCP demonstrator sites against key process and impact / outcome measures (including unintended effects)
  • Contribute to the developing evidence base on what are the critical success factors that may contribute towards reducing health disparities (as well as identifying barriers and factors that work less well)
  • Work with NHSE&I, the Department of Health & Social Care (DHSC) and its partners, to generate and disseminate learning that will support national policy and local delivery.

The evaluation is expected to build in structured opportunities for dynamic evaluative feedback, and reflexive learning for the CCCP and policy makers. Applicants should set-out suggestions for how to maximise these opportunities.

Inequalities

Addressing health and care inequalities and improving approaches to population health management are longstanding priorities for the health system, its partners and successive governments. It is also a central component of the CCCP, which provides a consistent framework for measuring and addressing health inequalities whilst also allowing for local flexibility and innovation.

There is national and local policy interest in understanding how to maximise the effectiveness of existing policies so as to improve the health of the poorest fastest, as well as understand why some local areas do well, and some less well, on health inequality measures. This includes, for example:

  • Enhancing the experience of care
  • Improving population health
  • Reducing costs by increasing value for money and efficiency
  • Improving staff experience at work
  • Developing a framework for tackling and measuring health inequalities

Research priorities

Set-out below are 4 high-level themes / challenges that are of interest to national policy makers. Beneath each heading, we have also added some example policy questions. This list is neither definitive or exhaustive; being intended to illustrate the areas of interest to national policy-makers, to inform implementation and future decisions. Applicants should consider how best to address these questions within a coherent study, and may also include additional related issues where justified.

Creating the right environment, locally and nationally

Overarching questions

  • How are primary care and system partners in CCCP demonstrator sites working together to best meet the complex care needs of people in their local areas with a focus on reducing disparities?
  • How is larger-scale spread and adoption being achieved?

Example supporting questions

  • What are the key barriers and enablers at neighbourhood level, particularly for PCNs, to bringing partners together to improve population health and reduce health disparities?
  • Are the sites demonstrating changes that can be scaled to reach a larger group of people and be adopted to help other population groups?

People

Overarching question

  • Is the CCCP advancing the ability for the primary care workforce to be recognised, supported, and developed as part of ‘one workforce’ so that it contributes to delivering more integrated models that improve population health, and help reduce health inequalities?

Example supporting questions

Establishing a flexible, multidisciplinary team
  • What are the key challenges sites are facing in bringing together workforce from across different organisations in a neighbourhood to form a multi-disciplinary team?
  • What are the key enablers in breaking down silos between organisations and enabling new ways of working?
Participation and engagement
  • Are sites measuring the impact of theCCCP on staff engagement, retention and job satisfaction, particularly in relation to their roles and career developing within the PCN?
Workforce planning and supervision
  • How are sites deciding what skills or roles are required, and how significant is the Additional Roles Reimbursement Scheme (ARRS) in this decision?
  • How does clinical supervision and accountability for the service pathway work?

Community and patient impact

Overarching questions

  • Is the CCCP facilitating improved access to local health and care services for the defined populations that the demonstrator sites are serving?
  • Is the CCCP approach strengthening the relationship between primary care, the communities and people it serves, and the wider health and social care system?

Example supporting questions

Public and patient experience of the initiative
  • Has the impact of the CCCP on reducing disparities and improving access, experience and outcomes for patients been measured at site level?
Emerging similarities
  • Is it possible to compare the change to date and impact of different interventions between sites where they have used similar approaches and/or focused on similar segments of the population?

Data and information

Overarching question

  • How are the demonstrator sites using data to better understand the needs of population groups and individuals being served to develop services where they are needed most?
  • How are demonstrator sites measuring outcomes for their target population?

Example supporting questions

Data-informed decisions and monitoring
  • How are sites deciding which segments of the population to focus on?
  • To what extent is the CCCP approach taken by demonstrator sites based on valid theories and principles drawn from causal data?
Support and capability
  • In the experience of the demonstrator sites, what support is needed to help make data-informed decision-making happen at PCN level, to improve the wider health of the population?
Measurable proxies for impact
  • Are demonstrator sites dealing with the right population to truly tackle the problem that has been identified, and how do they know?
  • Are CCCP interventions improving resource utilisation, efficient delivery, or increased productivity across the demonstrator sites?

Methods / Approach

This research should capture the diversity of local arrangements in demonstrator sites, enabling comparisons across sites. This will require multi-year and mixed methods approach. Applicants are requested to set out their methodological suggestions for qualitative and quantitative work packages. They should also identify appropriate primary and secondary data sources.

We invite outline proposals for the topic areas set out in this document using the NIHR PRP Stage 1 form specific to this call. At this stage, applicants are required to submit their plans and costs for the development phase component (initial assessment and feasibility testing), and also the mainstage evaluation.

We are conscious of the complexity of the CCCP, and the design and delivery challenges involved in such a complex and multi-faceted and multi-phased project. For this reason, the first phase of the research project should be to carry out an initial feasibility study which can baseline activity before proceeding to the main stage study phase.. For illustrative purposes, our planning assumptions are that the study will consist of two distinct phases:

  • Phase 1: baseline / mobilisation – consisting of an initial assessment of demonstrator sites, and a robust assessment of the research plan (testing scope and feasibility and costs)
  • Phase 2: main stage evaluation.

Within this phased approach, a review of phase 1 outputs and phase 2 plans will be carried out before the main stage commences. On completion of this initial phase, applicants will be required to set out their key findings in a report, and produce a separate output that reviews their main stage plans and costs This will provide the appointed evaluation team with the opportunity to refine their plans and adjust / reprofile the budget with NHSE&I and DHSC before the main stage of the study commences.

The feasibility study should build on any existing evaluation, data collection and analysis of current processes across the sites. This should then inform phase 2 of the research, with a focus on the impacts and outcomes of the project (measures to be informed by both this initial set of research question and the feasibility study). Given the number of different sites, interventions and populations, the feasibility study should determine how to focus on sites best suited to yield evidence that will answer key questions from the previous section.

Programme support

To assess the initial set-up of this programme, the CCCP PMO commissioned a preliminary study of formative research to help understand the design phase of each site, from the University of Central Lancashire. (A summary of this project is provided in Annex A).

The CCCP PMO will work closely with the successful applicants to support them throughout the course of this evaluation. This includes, for example

  • Providing administrative support in connecting with the sites, including making arrangements for any meetings
  • Providing detailed background information to individual demonstrator sites and their up-to-date operational development
  • Details of the work done and support for utilisation of the first report findings carried out by the University of Central Lancashire
  • Support from the facilitators in the PMO currently working with sites on their individual project development

Applications should be for both phases of research, anticipating costs for the feasibility stage of up to £300,000, and for the main study, up to an additional £800,000.

Areas of scope

The focus of this call is on evaluating existing interventions and approaches that are being adopted across demonstrator sites, and so not research to develop new interventions. In addition, the study should include the demonstrator sites that have taken part in the first (c.20) and second (c. 30) cohort groups or phases of the CCCP; unless researchers and the PMO ask to negotiate otherwise, we consider CCCP phase three sites to be out of scope.

While addressing health inequalities requires action across all the wider determinants of health, this call focuses on those that are actionable by the health and social care system including those led by Local Authorities. Actions outside the health and care system are out of scope for this call.

Outputs

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so the resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Policy milestones of relevance include the five-year framework contract for general practice, which concludes at the end of March 2024. The default position is that the existing GMS contract (and its add-ons) at that time will automatically roll forward unless it is changed.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, NHSE&I and other partners and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR Central Commissioning Facility. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

Budget and duration

Reflecting the requirements set out in this document, and our planning assumptions on study phasing, the funding available for this research is as follows:

  • Phase 1: initial process / formative evaluation, main stage feasibility testing, and finalisation of main stage plans – up to £300,000
  • Phase 2: main stage formative evaluation – up to £800,000

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

References and key documents

NHS (2021). CCCP demonstrator sites project prospectus. [Accessed May 2022]

Duffy (2022). Addressing health inequality through the lens of primary care. [Accessed May 2022]

Bodenheimer and Sinsky (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. [Accessed April 2022]

RAND Europe and Ernst & Young LLP (2012). National Evaluation of the Department of Health’s Integrated Care Pilots. [Accessed April 2022]

Nuffield Trust (2019). Evaluating integrated care - Why are evaluations not producing the results we expect? [Accessed April 2022]

NHS England (2018). GP Contract. [Accessed April 2022]

NHS England (2018). New care models. [Accessed April 2022]

Berwick, Nolan and Whittington (2008). The triple aim: care, health, and cost. [Accessed April 2022].

Sikka, Morath and Leape (2015). The Quadruple Aim: care, health, cost and meaning in work. [Accessed April 2022]

Institute of Health Equity (2010). Fair Society Healthy Lives (The Marmot Review). [Accessed April 2022]

Institute of Health Equity (2020). Health Equity in England: The Marmot Review 10 Years On. [Accessed April 2022]

Department of Health and Social Care (2018). Prevention is better than cure: our vision to help you live well for longer. [Accessed April 2022]

Public Health England (2019). Public Health Outcomes Framework. [Accessed April 2022]

NHS England (2016). Reducing health inequalities resources. [Accessed April 2022]

NHS England (2021). Core20PLUS5 aAn Approach to Reducing Health Inequalities: supporting information. [Accessed May 2022]

Annex A

UCLan Evaluation

The initial evaluation for the first phase of CCCP covers 19 demonstrator sites, and involves assessing a range of process measures – such as:

  • the extent of engagement of the relevant sectors in the network;
  • the level of harmonisation of objectives and priorities across the sectors
  • the use of policies and activities within the sectors to achieve the above
  • the extent of formalised collaboration within the sectors
  • the experience of collaboration amongst the sectors and the favourable contextual factors
  • Methods used include data transcription and analyses from internal and external publications; surveys; and interviews.