Health and social care integration - localities: guidance

Information about locality arrangements covering some of the practicalities that Integration Authorities should take into account when establishing and supporting localities.

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11 Participating In Localities

11.1 Different participants in localities will bring different skills and insights to the process. Working across and with one another is critical to the success of integration. People and communities will be enabled to flourish only where all parts of the system work collaboratively to empower local decision making and active citizenship. This section sets out some principles for the kind of experience that different participants should have.

11.2 General Practice. The GMS contract makes provision for every GP practice to nominate an integration liaison, which provides a starting point for GP engagement in integration.

11.3 GP involvement in localities will to some extent vary from place to place. The key principle is that GPs must be meaningfully and thoroughly represented, engaged and directly involved in localities. In some places, this could mean that the locality group includes a named GP, or other practice member, from every GP practice. In other places, it could mean that the locality group includes a GP, or other practice member, from each of its GP clusters. The role for these representatives, whether GPs themselves or other practice members, will be to meet with the locality lead on a regular basis, to provide a clinical community of leadership.

11.4 Agreement on GP membership of localities should be reached by the Integration Authority and the Local Medical Committee. Additionally, the contribution of local Area Clinical Forum and Professional Advisory Committees will be critical to the development of localities, and to ensuring that each representative group has the opportunity to contribute appropriately.

11.5 Primary Care. Each profession in the wider primary care team should have the opportunity to participate in the development of the locality plan and local decision making that affects their profession, either via membership of the locality or via a clear mechanism that enables them to feed into and be made aware of the decision making process.

11.6 Secondary Care. It will be important to take account of the views of people working in secondary care. Again, arrangements in this respect will vary from place to place; local Managed Clinical Network and Community Hospital arrangements will provide a starting point for secondary care engagement in localities. Clinicians and representatives from unscheduled care and geriatric medicine specialists, in particular, should be involved.

11.7 Housing. Localities should also take account of input from people who have responsibility for housing, given the focus within integration on supporting people, as far as possible, to stay in their own homes and building healthy, resilient communities.

11.8 Social Work and Social Care. Social workers, and people working in social care more generally, play an important role in helping people to maintain their independence; their input will be critical to effective locality arrangements.

11.9 Communities. People living locally must have a meaningful role in localities. Existing Public Participation Forums and local patient participation groups can play a valuable role as communities of interest, as can existing planning and consultative groups such as Community Councils or Local Area Networks.

11.10 Integration is intended specifically to improve care for people with complex support requirements. Many will be older people. Disabled people will also form a key constituency, for whom localities - and integration more widely - bring the opportunity to influence service design to make a really positive difference to their lives. It is often challenging for older people and disabled people to be heard, much less to engage meaningfully in co-production[9]. It will be important that localities are set up with accessibility and creativity in mind, particularly for people who are socially isolated. Integration Authorities should consider innovative approaches to engaging people, including identifying how third sector organisations may be better placed to facilitate the involvement of people for whom participation may present challenges.

11.11 The contribution of public health and health promotion is vitally important to support the evidence base of what each locality areas challenges are and to assist in making the biggest impact on inequalities.



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