The shift into Integrated Care Systems presents an opportunity to create an aligned approach to improving population health across NHS providers, Local Authorities, the community and voluntary sector and our residents. It allows us to re-appraise our local and system priorities together and encourages us to use the increasingly rich data available to target those in our communities with the greatest need, much of which is unmet.
Population Health Management is a way of working to help frontline teams and system planners understand current health and care needs and predict what residents will need in the future. It involves analysing data and using that intelligence to identify population cohorts (or segments) to allocate resources to those with the greatest need and where interventions will add most value. It is not a new concept, but the tools we have now and the new legislation in the Health and Care Act 2022 mean we can do more now than at any time in the past.
Working as a system, our health and care services can work together to design new proactive models of care which will improve health and wellbeing today as well as in the future. This way of working helps frontline teams understand current health and care needs and predict what local people will need in the future. This means we can tailor better care and support for individuals, design more joined-up and sustainable health and care services and make better use of public resources.
South West London Population Health Management Roadmap
In South West London we have involved multiple partners across the system in many varied ways to capture our collective aspiration for Population Health Management and create the South West London Population Health Management Roadmap. This clearly sets out the current context and the next steps required to improve our capability and capacity to enhance Population Health across South West London.
National Population Health Management Development Programme
We have also participated in the National Population Health Management Development Programme focused on selected Primary Care Networks and Sutton Borough and building on assets, enthusiasm and a learning-by-doing approach. This involved engagement with local communities, helping to change the way we think and behave across our system and to move away from a predominantly reactive approach to those presenting at the doors of our services to a more reflective, proactive way of working.
National exemplar
South West London ICS has come a long way since September 2021 and is now recognised as a national exemplar, yet we believe we are at the start of our development journey. We will continue to support system development, focusing on using our assets more effectively and ensuring that all in the system adopt a Population Health Management approach in the work that they do.
This will allow us to:
- reduce unwarranted variation in quality and outcomes
- avoid harm to patients
- prevent waste and failure to maximise value
- effectively tackle health inequalities and inequities
- and prevent disease.
How we’re making a difference
Get involved
If you would like to get involved in our Population Health Management work email us at [email protected]
Find out more about how you can get involved in our work on the Get Involved pages.