In the June edition of Partnership Update, we introduced Northamptonshire’s new Population Health Management (PHM) programme.

PHM uses data and predictive analytics to identify needs, join up services and deliver proactive personalised care for people in complex at-risk groups.

The aims of the programme are to develop a local approach to PHM and help progress a population health strategy, with a view to achieving the following ambitions:

• Establish a linked data set across primary care, hospital services and other health and care sectors

• Create enhanced leadership and support for PHM across the Northamptonshire Integrated Care System

• Explore physical health, mental health and social interventions for people in at-risk groups, using PHM data analytic techniques and developing evaluation methods to monitor progress

• Explore sustainable funding and resourcing models that accelerate proactive and integrated care across providers, supporting collaborative workforce models and a new local population-based incentive scheme

Northamptonshire’s PHM programme has four workstreams: System, Place, Primary Care Network (PCN) and Data and Analytics. Within each workstream there will be stakeholders from across our health and care system relevant to each area of work, and they will work as part of action learning sets towards achieving the key aims set out above.

Within our ICS, we will initially be looking at West Northamptonshire as a ‘Place of focus’ alongside the following four ‘PCNs of focus’: Red Kite, Grand Union, M-WEB and MMWF. This work will inform what the programme will ultimately develop into a county-wide approach to Population Health Management.

The next steps for the programme are for the required data from primary care and hospitals to be linked and shared for analysis. The programme team is working through the information governance to ensure this is a secure process.

Engagement will also take place to ensure essential stakeholders are briefed and prepared to input into the action learning sets, which will take place over 22 weeks between October 2021 and February 2022.