About COIN (Communities of Integration Network)

  COIN – Communities of Integration Network. 9 July 2019


What is COIN?


Communities of Integration Network (COIN) is a network of practitioners and academics supported by the three RCGP Faculties in London. The purpose of COIN is to advance the understanding and implementation of community-oriented integrated care


Community-oriented integrated care is a way of working that supports integration of healthcare and social care at a local level. In particular, it builds from the ideas presented in London Journal of Primary Care that considers general practice and public health to be well-placed to orchestrate grand alliances for health and care. Vertical integration links generalists with specialists, and horizontal integration links relevant local groups including a range of professionals and local people. Community-oriented integrated care is based on the principles of organisational learning to co-construct collaborative developments throughout whole systems. 


Community-oriented integrated care as envisaged by COIN, relates to three schools of thought:


  1. Community-based coordinating hubs, as described by the World Health Organisation’s Alma Ata Declaration (1978), to be a key part of ‘comprehensive primary healthcare’, within which all individuals and all organisations work together to create healthy societies;


  1. Collaborating for health (2018), the ideas put forward by Paul Thomas in the book – Collaborating for Health, Routledge, 2018;


  1. The NHS long-term plan, in January 2019 NHS England produced a plan to create “integration everywhere”, within a primary care-led NHS, which we interpret to mean community-oriented integrated care.


What COIN does


To further its aims, COIN:


  1. Raises the profile of community-oriented integrated care by supporting the publication of papers that reveal its nature and how to practically achieve it. 


  1. Works with Health Matters (online), to publish blogs that stimulate good community-oriented integrated care practice, nationally and internationally.


  1. Supports the development of case studies of community-oriented integrated care in practice and over time.


  1. Works with organisations that seek to use community-oriented integrated care methods, to understand their iterative nature, including oscillating between focused action and bigger pictures and between research evidence and lived experience.


  1. Works with academics and educators at all levels to develop programmes of learning about integrated working, especially for children in schools, undergraduate health professionals, established primary care and public health professionals, and multidisciplinary leadership teams that are developing integrated working. 


How COIN co-constructs new initiatives


    1. COIN meetings are focused on debating current challenges and opportunities to advance community-oriented integrated care and shape projects.
    2. COIN members support initiatives by facilitating co-construction of new approaches within broader communities.


  • Regular communication to (10,000) RCGP members allows COIN to contribute to the co-construction of new initiatives with London Region GPs and other interested communities. 



Initiatives that COIN supports


COIN works with energies and activists within the system. Where we find individuals who are deeply committed and motivated to implement community-oriented integrated care, and the situation presents an opportunity for realistic success, COIN uses its networks to strengthen these ‘hotspots’. 


COIN‘s support can take the form of facilitating groups to coalesce around an initiative, raising its profile through social media, and  providing a forum for constructive challenge and debate. 


COIN members can work with organisations that wish to implement community-oriented integrated care by providing expertise to achieve innovative projects, especially when success requires crystalizing consensus from multiple perspectives through co-construction of shared initiatives.


COIN will emphasise the following initiatives over the next three years:


  1. Case studies of community-oriented integrated care. The on-line journal Health Matters will publish blogs that provide new insights into previously published case studies of community-oriented integrated care, as well as new cases. COIN will encourage and support those sites/authors to write up their work for Health Matters, debate the issues arising, and publicize the lessons through social media;


  1. New approaches to Quality Improvement. We will promote an approach to quality improvement that considers whole systems as well as discrete initiatives, and we will highlight successful projects. For example, the Ealing (West London) integrated care pilot generated data that show how applying the principles of community-oriented integrated care achieves cost-effective outcomes across a range of measures. We will write papers about Ealing and other successful case studies and contribute to an evidence base to support the argument that quality improvements in healthcare should integrate focused whole systems improvements using 4th generation evaluation;


  1. Support COIN members to collaborate to co-design and/or evaluate initiatives.  For example, the development of policies and plans of Sustainability and Transformation partnerships (STP), Learning Hubs, and Clinical Commissioning Groups. 


  1. COIN members will contribute to the advancement of medical school and other curricula for students to learn skills to create environments for health as well as treating diseases. Learning outcomes will include five aspects of community-oriented integrated care: 1) Conceptual thinking; 2) Evaluation; 3) Facilitation of learning spaces; 4) Orchestration of whole system learning and change; 5) Skills for personal balance and leadership.


For more about the COIN vision, see: https://www.tandfonline.com/doi/full/10.1080/17571472.2018.1477455 

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