Place, sweet place

I am fortunate that I was the accountable officer for the Mid-Nottinghamshire clinical commissioning groups (CCGs) which cover Mansfield, Ashfield, Newark and Sherwood, a population of roughly 350,000 people. Within this, we have successful and struggling residents, from millionaires to children on free meals in schools. With its wide range of need, how do we serve this area? And how does this relate to the idea of place? 

Our journey began as the Better Together Programme, which covered the same geography and was selected as a vanguard site for integrated primary and acute care systems. In April 2016, an alliance was formed between the CCGs, local authority and key providers across Mid-Nottinghamshire. The aim was to deliver integrated models of care to transform the delivery of health and social care and drive system-wide financial benefits.

The focus of the alliance was to develop provider collaborations and commissioning approaches, initially with a specific focus on two services: musculoskeletal (MSK) conditions and end of life. Joint working meant pathways were changed for patients to provide a single point of access for patients, families and healthcare professionals when a patient is at the end of their life. 

For patients with MSK, advanced physiotherapist practitioners ask surgeons to refer patients directly to radiology, without the surgeon needing to see the patient. This is quicker for patients and has led to an 11.5 per cent reduction of new outpatient appointments, a 10.2 per cent reduction in day-cases and a 9.2 per cent reduction in planned admissions. The service will save over £3m in its first 18 months.

The relationships, and trust, formed in the vanguard put us in a strong place to move into an integrated care partnership (ICP) in April 2019, a change marked by more involvement from district council colleagues, an independent chair and co-location of ICP colleagues with the CCG.

As someone who has worked within the vanguard, the ICP and the overarching integrated care system, it is clear to me how fortunate we are within Mid-Nottinghamshire to have built the relationships between colleagues in different statutory organisations. 

Why is this important? Because the Long Term Plan makes it clear services will have 
to change. The only way we can do this responsibly is by working together and focusing on what is best for the people in their ‘place.’

Our definition of place can be very different from that of the residents within them. We cover Mid-Nottinghamshire, but we know outside of our organisations, that is a rarely used term. Our citizens are more likely to refer to Ashfield, Mansfield or Newark. But they are even more likely to refer to their own neighbourhoods within those, such as Sutton, Bull Farm or Ollerton. 

Our challenge then is to look at the themes from across those areas and see how we can work together in the ICP to improve healthy life expectancy while recognising the individual characteristics of those neighbourhoods.

Place could be criticised as being vague, but I see it as an opportunity to learn from residents – what it means to them, what they want to improve in it, and how, as an ICP, we can bring together our resources to do that. For me, that is the value of place.

Amanda Sullivan is the accountable officer for Mid-Nottinghamshire clinical commissioning groups and is now working across the Nottingham and Nottinghamshire Integrated Care System. She is also a member of NHS Clinical Commissioners' board.

Find out more

Gain insights on place-based leadership in Mid-Nottinghamshire on this one-hour webinar on 13 March.

Hear from:

• Amanda Sullivan, Accountable Officer, Mansfield and Ashfield CCG and Newark and Sherwood CCG
• Richard Mitchell, Chief Executive of Sherwood Forest NHS Foundation Trust and Executive Lead for Mid-Nottinghamshire ICP
• Dr Andy Haynes, Managing Director of Nottingham and Nottinghamshire Integrated Care System