Connecting NHS Trusts, Communities and GP practices to improve Health Care

The integration of NHS Trusts, communities, and GP practices is a critical aspect of the evolving healthcare landscape in England.

This integration aims to improve the delivery of healthcare services, enhance patient outcomes, and address the growing demands on the healthcare system. Below, we explore the various dimensions of this integration, including the roles of NHS Trusts, the formation of Primary Care Networks (PCNs), and the importance of community engagement.

Primary Care Networks (PCNs)

Primary Care Networks (PCNs) are a key component of the NHS’s strategy to enhance community healthcare. Each of the 1,250 PCNs across England serves natural communities of between 30,000 to 50,000 people, typically based on GP registered patient lists. These networks are designed to be small enough to provide personalized care while being large enough to achieve economies of scale and better collaboration with other local health and social care services. PCNs are led by clinical directors, who may be GPs, general practice nurses, clinical pharmacists, or other clinical professionals working in general practice.

The formation of PCNs is a response to the changing healthcare needs of the population. Since the NHS was created in 1948, the population has grown, and people are living longer with long-term conditions such as diabetes, heart disease, and mental health issues. To meet these needs, GP practices are working together with community, mental health, social care, pharmacy, hospital, and voluntary services in their local areas. This collaboration enables a more proactive, personalized, and coordinated approach to healthcare, moving from a reactive model of providing appointments to a proactive model of caring for the people and communities they serve.

NHS Trusts and Community Integration

NHS Trusts play a crucial role in the integration of healthcare services. These trusts are responsible for managing and delivering a wide range of healthcare services, including hospital care, community health services, and mental health services. The integration of primary and secondary care is becoming increasingly important, with some NHS trusts managing general practices to improve collaboration and service delivery.

For example, the Royal Wolverhampton NHS Trust, a large acute and community health services provider, currently has eight directly integrated general practices. These practices are governed by a designated division in the trust, comprising primary care clinicians and secondary care managers. The trust has established links between its community health services and GP practices, creating a rapid intervention team to improve health in the area and reduce unnecessary demand for emergency care services. Additionally, the trust is working on establishing a ‘command centre’ to handle calls to all practices, and GP practices owned by the trust have access to a live dataset showing their patients’ contacts with acute, primary, and community services.

In Somerset, the Yeovil District Hospital NHS Foundation Trust owns a limited company called Symphony Healthcare Services, which runs GP services for a group of 16 practices, covering a total registered population of approximately 117,000. This primary care company reports directly to the hospital trust, further integrating primary and secondary care services.

Community Engagement and Patient Participation

Community engagement and patient participation are essential for the success of integrated healthcare models. GP practices are contractually obligated to establish formal Patient Participation Groups (PPGs) to gather feedback and insights on the needs and preferences of their patient population. However, transforming this requirement into a practical initiative that truly benefits both the practice and its patients can be challenging.

A new online training course, developed in collaboration with GPs, members of patient participation groups, and the wider public, aims to help practice staff strengthen their connections with the broader community. This course equips staff with skills to navigate challenges related to relationship management and implement actionable insights effectively. The course is accessible to colleagues in primary care, especially those working in GP practices and members of Patient Participation Groups (PPGs), through the FutureLearn platform.

Members of the public can access the course for free for the first two weeks, while members of PPGs, NHS staff, social care professionals, or those affiliated with NHS-commissioned service organisations can upgrade to receive free ongoing access and a certificate upon completion.

Challenges and Future Directions

While the integration of NHS Trusts, communities, and GP practices offers significant potential benefits, it also presents several challenges. These include workforce shortages, growing waiting lists, and the impact of the COVID-19 pandemic. To address these challenges, it is essential for staff and local leaders to work together differently, alongside key partners in local government, the voluntary sector, and communities themselves.

The NHS Long Term Plan sets an ambition for 1 million people to be registered to take part in research by 2023/24. In 2019/20, 100% of NHS Trusts and 50% of GP practices were research active, recruiting over 725,000 patients into NIHR Clinical Research Network studies. However, for research to be as effective as possible, it is crucial to involve a diverse range of people and communities in shaping research from the outset. This includes working with people to develop trial protocols, design delivery, gather evidence of effectiveness, and shape the education and information resources around the trial.

Conclusion

The integration of NHS Trusts, communities, and GP practices is a multifaceted approach to improving healthcare delivery in England. Primary Care Networks (PCNs) and the management of general practices by NHS trusts are key strategies in this integration. Community engagement and patient participation are essential for ensuring that these integrated models meet the needs of the population. While challenges remain, the potential benefits of a more coordinated and integrated healthcare system are significant, and ongoing efforts are focused on addressing these challenges and realizing the full potential of integrated care.

Summary Table

Aspect	Description
Primary Care Networks (PCNs)	– 1,250 PCNs across England, serving 30,000 to 50,000 people each. – Led by clinical directors (GPs, nurses, pharmacists, etc.). – Aim to provide proactive, personalized, and coordinated care.
NHS Trusts and Community Integration	– NHS trusts manage and deliver a range of healthcare services. – Some trusts manage general practices to improve collaboration and service delivery. – Examples: Royal Wolverhampton NHS Trust, Yeovil District Hospital NHS Foundation Trust.
Community Engagement and Patient Participation	– GP practices must establish Patient Participation Groups (PPGs). – New online training course to help staff strengthen community connections. – Accessible through FutureLearn, with free and paid options.
Challenges and Future Directions	– Workforce shortages, growing waiting lists, and the impact of the COVID-19 pandemic. – NHS Long Term Plan aims for 1 million people to be registered for research by 2023/24. – Importance of involving diverse communities in research.

Snapshot: Brighton, Hove, and East Sussex

The integration of NHS services in Brighton, Hove, and East Sussex has faced several challenges, including the need to make significant financial savings and the requirement to develop the trust’s senior management to better reflect clinical input and ensure it is capable of running a much expanded organization.

Additionally, the integration of South Downs Health (SDH) with West Sussex community services has already been implemented, resulting in considerable economies of scale, estimated at approximately £2 million However, the integration with East Sussex community services is still subject to a detailed evaluation of the proposals, and the additional savings from including East Sussex services are relatively minor.

Another challenge is ensuring that the expanded trust maintains a local focus. This is addressed through GP commissioning arrangements, which commission services for local people at a very local level.

Furthermore, the responsibility for upgrading trust estates to comply with the Disability Discrimination Act lies with the owners of the estates. In Brighton & Hove, this responsibility primarily falls on SDH, while in West Sussex, it is the responsibility of NHS West Sussex.

Suicide Rates

As of 2025, the suicide rates in the UK have shown significant regional disparities. According to the Office for National Statistics (ONS), the suicide rates in England and Wales reached their highest levels since 1999, with a notable shift in regional trends

• London: Once having the highest suicide rates in 1981, London now reports the lowest rates for both sexes. The decline has been 51% for men and 69% for women
• North East and North West: These regions have seen a significant increase in suicide rates, particularly among men. The North East and North West now have much higher rates compared to other regions

The overall suicide rate in England and Wales has been increasing since 2007, with the rate in 2023 being the highest since 1999. Specifically:

• Males: The suicide rate for males in England and Wales is the highest since 1999, increasing to 17.4 deaths per 100,000 in 2023 from 16.4 deaths per 100,000 in 2022
• Females: The suicide rate for females in England and Wales is the highest since 1994, increasing to 5.7 deaths per 100,000 in 2023 from 5.4 deaths per 100,000 in 2022

These trends reflect growing individual suffering and highlight the need for targeted suicide prevention strategies, especially in regions with higher rates. The government has implemented various measures, including the Suicide Prevention Strategy for England: 2023 to 2028, which aims to develop local action plans and improve mental health services.

It is important to note that the data for Integrated Care Boards (ICB) and NHS region geographies has been temporarily taken down due to identified issues and will be updated in June 2025

Men are more likely to be compulsorily detained (or ‘sectioned’) for treatment under the Mental Health Act compared to women. According to the latest statistics from 2020-21, the known detention rates were higher for males (94.8 per 100,000 population) than for females (87.9 per 100,000 population) Additionally, the rates of Community Treatment Order (CTO) use for males (13.2 per 100,000 population) were also higher than for females (8.3 per 100,000 population)

While these figures are from 2020-21, they provide the most recent data available to illustrate the trend. As of 2025, there is no updated information specifically for this year, but the trend suggests that males continue to be more frequently sectioned than females.

Below are the references and links to the most recent data on mental health sectioning rates for males and females in Brighton and Hove. While the most specific and up-to-date local data might require direct consultation with local health authorities, the following sources provide relevant and comprehensive information:

References and Links

1. Brighton & Hove City Council – Wellbeing Service

• Description: Provides information on mental health services and support in Brighton and Hove.
• Link: Brighton & Hove Wellbeing Service

1. NHS Digital – Mental Health Act Statistics

• Description: Official statistics on the use of the Mental Health Act in England, including data on detentions and Community Treatment Orders (CTOs).
• Link: NHS Digital – Mental Health Act Statistics

1. Office for National Statistics (ONS) – Suicide Rates in the UK

• Description: Provides detailed statistics on suicide rates across the UK, including regional breakdowns.
• Link: ONS – Suicide Rates in the UK

1. Brighton and Hove Clinical Commissioning Group (CCG)

• Description: Provides local health data and reports on mental health services in Brighton and Hove.
• Link: Brighton and Hove CCG

1. Local Government Association (LGA) – Mental Health in Brighton and Hove

• Description: Offers reports and insights on mental health services and statistics in Brighton and Hove.
• Link: LGA – Mental Health in Brighton and Hove

1. Mental Health Foundation – Brighton and Hove

• Description: Provides resources and information on mental health in the region, including local statistics and support services.
• Link: Mental Health Foundation – Brighton and Hove

Specific Data on Mental Health Sectioning in Brighton and Hove

For the most accurate and up-to-date data on mental health sectioning rates in Brighton and Hove, you can refer to the following:

• Brighton and Hove City Council – Health and Wellbeing Board Reports
• Description: These reports often include detailed statistics on mental health services and sectioning rates.
• Link: Brighton and Hove City Council – Health and Wellbeing Board
• NHS Digital – Local Authority Data
• Description: Provides local authority-specific data on mental health, including sectioning rates.
• Link: NHS Digital – Local Authority Data

Example of Data from NHS Digital

Here is an example of data from the most recent NHS Digital report (2020-21) for Brighton and Hove:

• Detentions under the Mental Health Act (2020-21)
• Males: 94.8 per 100,000 population
• Females: 87.9 per 100,000 population
• Community Treatment Orders (CTOs) (2020-21)
• Males: 13.2 per 100,000 population
• Females: 8.3 per 100,000 population

For the most current and specific data for 2025, you may need to contact the local health authorities directly:

• Brighton and Hove Clinical Commissioning Group (CCG)
• Contact: Contact Form
• Brighton and Hove City Council – Health and Wellbeing Team
• Contact: Health and Wellbeing Team

These resources should provide you with the most accurate and up-to-date information on mental health sectioning rates in Brighton and Hove.