Putting integrated care into practice: the North West London experience

In 2013, clinical commissioning groups (CCGs) and local authorities from across North West London joined with health, social care and other partners to form an alliance intended to drive the development and implementation of a large-scale programme of integrated care. The Whole Systems Integrated Care (WSIC) programme covers the care needs of people in eight London boroughs: Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea, and the City of Westminster. 

This programme is the largest of the 14 integrated care pioneers launched by the Coalition Government in 2013 to remove barriers to integrated care and enable it to be extended ‘at scale and pace’. 

The Nuffield Trust and the London School of Economics and Political Science were commissioned to evaluate the programme’s early stages from February 2014 to late April 2015, providing independent assessment of the initial processes and progress to date. The evaluation was formative in nature, providing feedback and challenge as part of the programme’s commitment to adaptive learning.

The evaluation does not aim to draw a verdict on the success of integrated care and the impact on care services in North West London, but rather to assess and provide feedback on the approach to designing an integrated care programme. 

The programme is ambitious and well-resourced through funding from the pooled budgets of the North West London Collaboration of CCGs. As a result, it has been able to make significant investments in co-design and planning, before developing pilot schemes, known as ‘early adopters’.

However, the programme was more than a year behind schedule when the evaluation ended and it had yet to deliver significant service change. The findings therefore reveal valuable lessons for other policy-makers and practitioners leading integrated care schemes, namely in the challenges of moving from planning and design to delivering service change. 

Research findings

For more information about this evaluation, please see the research summary, or for an indepth look, download the full research findings. 

Surveys: 

As part of this evaluation, the Nuffield Trust also conducted two surveys.

1. Early adopters steering committee

The WSIC programme established nine local initiatives (‘Early Adopters’) to pilot and implement the programme at the local level. We surveyed the Early Adopter steering committee members between 13 November and 17 December 2014. The survey explored members’ perceptions of their early adopter’s progress, the usefulness of the WSIC Integrated Care Toolkit and its design process, as well as different groups’ involvement in the project. A total of 109 steering committee members responded to the survey giving an overall response rate of 60 per cent.

2. GPs view of integration in North West London

This survey was aimed at GPs in North West London – including those who were not directly involved in the WSIC programme. It was designed primarily to gather views on integrated care and what needs to happen locally to achieve change,  for example by exploring GPs’ perceptions of their relationships with other sectors. Respondents were also asked about awareness of the WSIC programme.

The survey was fielded between 24 March 2015 and 8 May 2015, with one GP in each practice being asked to complete it. A total of 160 responses were received, giving a response rate of 39 per cent (assuming that one person per practice completed it).