Introduction:Population Health Management (PHM) is a UK priority for Integrated Care Systems (ICSs), aiming to deliver proactive, preventative, person-centred care using integrated health and care datasets. However, evidence on implementation in primary care remains limited. Methods:This comparative case study used embedded researchers, ethnography, interviews, and observations to formatively evaluate a 24-month PHM programme across 31 Primary Care Networks in one ICS. Data were thematically analysed using Excel and NVivo, with findings fed back to participants to guide programme delivery. Results:Around 200 stakeholders participated in Action Learning Sets, fostering cross-sector collaboration within four localities. Few innovations, developed using integrated datasets, progressed to delivery, limiting their impact on patient health. While PHM infrastructure was established, delivery was constrained by operational pressures, data governance challenges, limited resources, lack of strategic integration and the nature of local relationships. Discussion:Effective PHM implementation requires more than infrastructure and governance. It depends on developing system-wide soft skills (facilitation, co-production), motivating stakeholders, and investing in processes that support insight generation, innovation piloting, and evidencing of impact. Conclusion:The study highlights the need for stronger strategic integration, sustained resourcing, coordination, and co-production to realise PHM's potential at system, place and neighbourhood levels in addressing health inequalities and improving population outcomes.

Background: There are well-documented differences in cancer survival between people from low and high-income areas but despite initiatives to improve mortality these inequities prevail (1). By capitalising on the assets of those living within lower-income communities, healthcare inequities may be reduced (2). Macmillan Cancer Support, a national cancer charity, has partnered with local Voluntary and Community Sector (VCS) organisations in the United Kingdom to reduce the drivers of inequity in cancer care specifically relating to knowledge of cancer, equitable experiences, timely diagnosis and access to treatment (3). In Plymouth, a low-income city in the South-West of England, cancer mortality rates are significantly higher than the national average (4). Here, Macmillan has partnered with Zebra (a Plymouth community collective working toward social and environmental justice), Age UK Plymouth (a charity working in the community to support individuals over 50), and The Wolseley Trust (a Community Development Trust fostering community involvement including social prescribing), as well as local General Practice (GP) surgeries to explore an asset-based community development approach to tackle cancer care inequity in low-income areas of Plymouth (5,6,7). Approach: The project launched in Summer 2023, and the project team was recruited by April 2024. To date they have hosted seven community cancer awareness and support events to address these inequities through community-led approaches. The Principal Investigator (PI) is a General Practitioner in training, with Zebra they are taking an embedded ethnographic action-research approach to explore how the PCCP influences Plymouth communities’ engagement with cancer services. The University of Plymouth has ethically approved this project. Twelve PCCP stakeholders have been recruited as participants. Data from naturally occurring events such as meetings, cancer awareness events, and participant reflective logs have been collected, and focus groups will be facilitated in late 2024. The PI has delivered training on cancer, health equity and primary care. Results and implications: The PCCP has begun to unearth barriers to cancer care for local people facing mental health issues, financial difficulties, substance dependence, homelessness, as well as those from minority groups. Following decades of community work, Zebra’s longstanding relationship with their community has enabled them to engage with local citizens in a rapid yet deep manner alongside the PCCP partners. Zebra is acting as a web, connecting healthcare providers, community resources, and citizens, forming a network to address cancer inequities and foster deeper community connection through meaningful engagement via an asset-based community development approach. References 1.Baker, C., Mansfield, Z. Cancer statistics for England. 2023. London: House of Commons Library. 2.Edwards-Smith, L., Hayes, J. (2023). Community Asset Network - addressing Disparities in Outcomes. Available at: https://www.plymouth.ac.uk/research/primarycare/public-health/devon-community-assets-research-collaborative. (Accessed 23rd September 2024). 3.Macmillan Community Cancer Champions. Available at: https://www.macmillan.org.uk/donate/philanthropy/our-funding-priorities/macmillan-community-cancer-champions. (Accessed 23rd September 2024). 4.Office for Health Improvements and Disparities. (2021). Health Profile of the South-West of England 2021. Available at: www.gov.uk/government/publications/health-profiles-for-english-regions-2021. (Accessed 19th January 2024). 5.Zebra. Available at: https://www.zebra.coop/. (Accessed 23rd September 2024). 6.Age UK Plymouth. Available at: https://www.ageuk.org.uk/plymouth/. (Accessed 23rd September 2024). 7.Wolseley Trust. Available at: https://www.wolseley-trust.org/index.php?option=com_k2&view=item&layout=item&id=24. (Accessed 23rd September 2024).

Introduction:This case study provides practice-based reflections on challenges and potential solutions for young people with multiple disadvantages across housing, substance misuse, mental health, criminal justice, and domestic abuse systems, informed by 4 local principles: trauma informed, learning based, an alliance commissioning ethos, and workforce development. Description:To improve the current experiences of 17-25-year-olds in service transition iterative insights drew from networking staff across sectors, clinical audit and following live cases, and appreciative enquiries with young people. This was conducted by a practitioner researcher in a local Young Person's charity and was supported by peer researchers with lived experience and embedded researchers-in-residence. Discussion:This describes the scale of the challenge where compound need and intersectional disadvantage, wider determinants, complex pathways, and public and third sector service systems collide. Relational practices were tested to support navigating system challenges, better tailor to young people's abilities and needs and improve integrated care partnership working and workforce development. Conclusion:Plymouth has a history of integration with the Alliance for Complex Needs. Context and localised solutions matter for integrating care, yet remain underreported especially for underserved, and marginalised young people and using whole systems approaches co-produced with the third sector. Investment into academia-practice partnerships is crucial to make learning portable.

Appreciative inquiry has become increasingly popular as a method for facilitating organisational or systemic change through focusing on the positive aspects and ‘life giving properties of a system’ as opposed to traditional ‘deficit-based’ approaches. However, there has been criticism that this process could invalidate negative experiences of organisations and/or systems. This is particularly problematic if an existing system is seen by its users as providing little value or if there is potential dissonance regarding system value among key stakeholders. Using two case studies of open appreciative inquiry by Plymouth City Council staff, this article outlines how the use of a liberally defined, human-learning-system informed, approach to appreciative inquiry has been used not to identify positive narratives so much as to surface potential dissonance and develop empathy and deeper insight conducive to systemic change. It concludes with a discussion of factors that might help organisations use appreciative inquiry where dissonance is likely to exist and a tentative labelling of this approach as “open appreciative enquiry” with an emphasis on the “e”.

Children and young people’s mental health and well-being has seen a dramatic decline. In the UK, this has been exacerbated by service retrenchment associated with austerity, with evidence of increasing health inequalities. Service innovation that is grounded in practice, has ongoing learning, and is co-designed with children and young people is required now. This can provide creative solutions within the local context and contribute to the fledgling evidence base that explores complex mechanisms of impact. This methodological reflection describes a co-design process of a bespoke, group-based ecotherapy programme: from early piloting using appreciative enquiry before COVID-19 by the mental health, public health, and Street Services team in the port city of Plymouth, to further developing an evaluation framework through an innovative, matched-funded academia–practice partnership. The findings showcase the benefits of a systems-based approach to public, multi-agency and academic collaboration, facilitated by peer and practitioner researchers and embedded researchers-in-residence. They highlight the need to consider nuances of specific (connecting with self, others, animals, nature) and non-specific active ingredients of the emerging and constantly adapting service (therapeutic relationship with practitioners/carers; nature as therapist, and group dynamics), as well as the value of pragmatic and participatory evaluation methods (distance-travelled, goal-based measures; and ethnographic, qualitative observation), to provide rapid, continuous, and real-time learning and improvement.

Background:Cancer survival rates vary significantly between low and high-income areas. By leveraging community assets, healthcare inequities may be addressed. Nationally, Macmillan Cancer Support (Macmillan) (a national cancer charity) is working with local Voluntary and Community Sector (VCS) organisations to improve cancer care.In Plymouth, where cancer mortality is above average, Macmillan has partnered with the Zebra Collective (Zebra) (a community cooperative), Age UK Plymouth (a local charity), The Wolseley Trust (Social Prescribing team), and General Practice (GP) surgeries. In Spring 2024, the Plymouth Cancer Champions' Project (PCCP) launched to address these inequities through community-led approaches via peer-to-peer community engagement and volunteer recruitment. Approach:This Integrated Care Case is a practice-based account of how through an embedded ethnographic action research approach, a small community cooperative (Zebra) is influencing its' local low-income community's understanding of and engagement with cancer care services from an asset-based community development approach. Findings:The PCCP prioritises involving individuals with lived experience, including those from lower socio-economic status backgrounds, minoritised ethnic groups, and cancer-affected backgrounds, in leadership roles. This collaborative, community-driven approach fosters inclusivity, empowerment, and engagement, and a deep contextual understanding of the community context including barriers and strengths. Through an innovative asset-based community development approach, the deficit narrative is countered- enabling people-led change, influence and learning within cancer care inequity and integrated care.

Effective Early Help services are key to halting rising rates of children in care in the UK. Yet despite family support and child welfare interventions being unequally distributed across the country, the role of ‘place’ has received limited attention in the children’s social care arena. This paper examines the connections between coastal challenges, Early Help and child welfare interventions, drawing on embedded research undertaken within a Local Authority on England’s coast with elevated levels of children in care. We focus on families’ experiences raising children in a seaside resort area as well as professionals’ perspectives on the place-based challenges faced delivering effective and accessible Early Help support. The study generated data from ethnographic observations, semi-structured interviews, and focus groups with local parents/carers (n = 57), service managers and frontline professionals (n = 14), and the Voluntary, Community, and Social Enterprise (VCSE) sector (n = 22). The findings highlight how the socio-economic challenges associated with many seaside resort areas, including housing pressures, a seasonal and low-wage economy, and the transience of the population, present difficulties for parents/carers in raising and supporting their children. For professionals delivering Early Help, high levels of housing instability, elevated inward migration, resource constraints and challenges around recruitment and retention presented challenges to delivering services. This paper recommends increased emphasis in regulation and resourcing around family support that considers the spatial and geographic dynamics that influence the incidence, structuring, and experiences of child and family welfare.

The UK housing crisis is having a detrimental impact on the lives of families. However, in England the links between housing and Children's Social Care remain poorly understood. This paper draws upon 24 months of embedded research within Torbay Council, a Local Authority with comparatively high rates of children in care and acute housing challenges. It includes qualitative data from interviews/focus groups with parents (n = 66); Children's Services professionals (n = 7), the housing department (n = 2); housing association (n = 2); and staff/volunteers from voluntary and community Sector organisations (n = 28). This study shows that housing circumstances can both trigger crisis situations leading to the involvement of Children's Services and form a critical element of the complex needs many families in contact with Children's Services confront. Parents described difficulties demonstrating their parenting abilities to Children's Services and the Family Courts when living in inadequate housing, or indeed when homeless. This paper recommends better alignment of Housing and Children's Social Care responses to ensure more effective support for families.

The independent review of children's social care (2022) has proposed a radical reset of England's children's services, shifting a remote, assessment heavy system towards one that works alongside communities to help prevent statutory interventions. However, notions around the harnessing of community resources to deliver Early Help are often underpinned by assumptions regarding the voluntary, community and social enterprise (VCSE) sector and the ease with which such organizations can be integrated into preventative strategies. This paper reports findings from embedded research within a unitary authority in Southwest England during remodelling of its Early Help service to work more collaboratively with local VCSE organizations. The study generated data from ethnographic observations, semi-structured interviews and focus groups with 95 participants, including local parents, service providers, VCSE organizations and Council leaders. The findings illustrate that families value the compassionate, responsive and flexible support available within many VCSE settings. However, differences in practice cultures, regulatory pressures on statutory providers, the need to (re)build trust in communities and sensitivities around power-sharing and resourcing meant negotiating VCSE sector integration was fraught with complexities. Few studies have gained such privileged access to a Local Authority's remodelling of Early Help services, and this paper has significant insights for the debates surrounding the independent review of children's social care (2022) and its recommendation to bring services 'closer to communities'.

Emerging evidence suggests that connecting people to non-medical activities in the community (social prescribing) may relieve pressure on services by promoting autonomy and resilience, thereby improving well-being and self-management of health. This way of working has a long history in the voluntary and community sector but has only recently been widely funded by the National Health Service (NHS) in England and implemented in Primary Care Networks (PCNs). The COVID-19 global pandemic coincided with this new service. There is wide variation in how social prescribing is implemented and scant evidence comparing different delivery models. As embedded researchers within an Integrated Care System in the Southwest of England, we examined the impact of COVID on the implementation of social prescribing in different employing organisations during the period March 2020 to April 2021. Data were collected from observations and field notes recorded during virtual interactions with over 80 social prescribing practitioners and an online survey of 52 social prescribing practitioners and middle managers. We conceptualise social prescribing as a pathway comprising access, engagement and activities, facilitated by workforce and community assets and strategic partnerships. We found that these elements were all impacted by the pandemic, but to different degrees according to the way the service was contracted, whether referrals (access) and approach (engagement) were universal ('open') or targeted ('boundaried') and the extent to which practitioners' roles were protected or shifted towards immediate COVID-specific work. Social prescribers contracted in PCNs were more likely to operate an 'open' model, although boundaries were developing over time. We suggest the presence of an explicit, agreed delivery model (whether 'open' or 'boundaried') might create a more coherent approach less likely to result in practitioner role drift, whilst allowing flexibility to adjust to the pandemic and enhancing practitioner satisfaction and well-being. The potential consequences of different models are examined.

Background This study evaluates the effectiveness of a targeted telephone-based case management service that aimed to reduce ED attendance amongst frequent attenders, known to disproportionately contribute to demand. Evidence on the effectiveness of these services varies. Methods A 24-month controlled before-and-after study, following 808 patients (128 cases and 680 controls (41 were non-compliant)) who were offered the service in the first four months of operation within a UK ED department. Patients stratified as high-risk of reattending ED within 6 months by a predictive model were manually screened. Those positively reviewed were offered a non-clinical, nurse-led, telephone-based health coaching, consisting of care planning, coordination and goal setting for up to 9 months. Service effectiveness was estimated using a difference-in-differences (DiD) analysis. Incident rate of ED and Minor Injury Unit (MIU) attendances and average length of stay in intervention recipients and controls over 12 months after receiving their service offer following ED attendance were compared, adjusting for the prior 12-month period, sex and age, to give an incidence rate ratio (IRR). Results Intervention recipients were more likely to be female (63.3% versus 55.4%), younger (mean of 69 years versus 76 years), and have higher levels of ED activity (except for MIU) than controls. Mean rates fell between periods for all outcomes (except for MIU attendance). The Intention-to-Treat analysis indicated non-statistically significant effect of the intervention in reducing all outcomes, except for MIU attendances, with IRRs: ED attendances, 0.856 (95% CI: 0.631, 1.160); ED admissions, 0.871 (95% CI: 0.628, 1.208); length of stay for emergency and elective admissions: 0.844 (95% CI: 0.619, 1.151) and 0.781 (95% CI: 0.420, 1.454). MIU attendance increased with an IRR: 2.638 (95% CI: 1.041, 6.680). Conclusions Telephone-based health coaching appears to be effective in reducing ED attendances and admissions, with shorter lengths of stay, in intervention recipients over controls. Future studies need to capture outcomes beyond acute activity, and better understand how services like this provide added value.

Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model). Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together withad hocdata collected on referral-type, staff inputs and patient experience (N = 72). Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%). Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

PurposeThis integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.Design/methodology/approachThis is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.FindingsThe cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.Research limitations/implicationsTo consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.Practical implicationsHow a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.Social implicationsTo combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.Originality/valueThe hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded ‘Researchers in Residence’ to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcome-focused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes.

Objectives This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM). Design A qualitative study embedded within a multicentre, single blind, randomised controlled trial (the PREVENT trial). Setting Primary care urban and rural settings in the UK. Participants 42 people who participated in the MBCT arm of the parent trial were purposively sampled to represent a range of recovery journeys. Interventions MBCT involves eight weekly group sessions, with four refresher sessions offered in the year following the end of the programme. It was adapted to offer bespoke support around ADM tapering and discontinuation. Methods Written feedback and structured in-depth interviews were collected in the 2 years after participants undertook MBCT. Data were analysed using thematic analysis and case studies constructed to illustrate the findings. Results People with recurrent depression have unique recovery journeys that shape and are shaped by their pharmacological and psychological treatment choices. Their journeys typically include several over-arching themes: (1) beliefs about the causes of depression, both biological and psychosocial; (2) personal agency, including expectations about their role in recovery and treatment; (3) acceptance, both of depression itself and the recovery journey; (4) quality of life; (5) experiences and perspectives on ADM and ADM tapering-discontinuation; and (6) the role of general practitioners, both positive and negative. Conclusions People with recurrent depression describe unique, complex recovery journeys shaped by their experiences of depression, treatment and interactions with health professionals. Understanding how several themes coalesce for each individual can both support their recovery and treatment choices as well as health professionals in providing more accessible, collaborative, individualised and empowering care. Trial registration number Clinical trial number NCT26666654 ; post results.

Aim: To evaluate the impact of 'holistic' link-workers on service users' well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (>= 50 years) with complex health needs (>= 2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>5000 pound change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.

Background / aims / objectives ‘Embedded’ approaches to knowledge mobilisation are gaining currency, as health and social care services come under increasing pressure to redesign services now rather than wait for research. One such approach is the ‘Researcher-in-Residence’ (RiR) model which seeks to co-produce knowledge for action. The aim of this paper is to extend the evidence base regarding mechanisms of impact. Methods A two-year mixed-method case study of the experience and impact of two part-time RiRs, embedded within an Integrated Care Organisation to support the implementation of new models of care. Data included the results of an anonymous impact survey sent to 80 key stakeholders, field notes of meetings (n=112), and observations of naturally occurring events (n=68). Findings Impacts were identified in relation to use of co-produced evidence, capacity building, changes in ways of working, and to a lesser degree changes in operations or strategy. Impact involved learning which was mediated by three non-linear, non-predictable, positive and negative feedback cycles (expectations, access, learning/ improvement). A mixture of technical skills, personal attributes and behaviours were identified as key to this mediation. Discussion/conclusion The RiR model promises a timely, applied and transferable research model that contributes to the development, evaluation and adaptation of innovations that seek to integrate services where the evidence base is weak and uncertain. However, the model is not without challenges. These could be addressed by flexibility of research design and funding, and adequately supporting and developing key attributes of RiRs.

Background: Experience and evidence from the Integrated Care Organisation (ICO) in Torbay and South Devon, UK show that implementation of fully integrated systems (comprising acute, community, primary, social, and voluntary services) require, amongst others, leadership and a co-produced engagement approach to foster a shared culture. Aims and Objectives: This is an interactive workshop to explore with participants through plenary and small group, flipcharts, and a prioritisation exercise relevant elements of the ‘Context and Capabilities for Integrated Care’ (CCIC) implementation framework for integration. The outcome is to identify with participants the elements which are most salient and critical (both as facilitator and barriers), how they interact with key processes and outcomes of system transformation, and to discuss emerging best practice and potential solutions. Format (timing, speakers, discussion, group work, etc): The workshop is facilitated by key leaders, representative of the wider system: Dawn Butler - Deputy Director of Strategy, Performance and Planning, Torbay and South Devon NHS Foundation Trust [TSDFT]; Dr Matthew Fox –GP, Locality Clinical Director TSDFT, Governing Body Locality GP (Coastal) South Devon and Torbay Clinical Commissioning Group [CCG], Chloe Myers - Manager, Volunteering In Health @ Coastal Information Centre. Researchers-in-Residence Dr Felix Gradinger, and Dr Julian Elston (University of Plymouth). If participants are consenting to do so, researchers would aim to capture and record the content of the workshop for co-production of research, learning and dissemination. Timing: 90minutes required 10mins: Introductions, co-production aim, overview Clarify and manage expectations, consent 25mins Introducing speakers and 5mins pitch each, RIRs to introduce CCIC framework and relevant domains; Brainstorming exercise (depending on numbers split into 3 or 4 groups each allocated to key elements), Showcase Torbay story; Highlight leadership domains/approaches and interdependence at system level, explain method and highlighted main elements 5mins Individual exercise, prioritising and thinking of examples for key elements; think about how most important elements link to others in the framework in own context; Get people to think about examples from their own practice 25mins Collectively rank around table/group and make links to other elements, consider solutions of how challenges were overcome; and discuss examples for feedback to the plenary (using flip charts); Get people to share why and how links start emerging; reach consensus around feedback from group and prepare to share in plenary 20mins Plenary and live feedback populating domains on whiteboard tying up most important connections and solutions; Start making connections between key elements across domains, formulate best practice elements 5mins End; summary and next steps; Encourage people to think about how to apply this personally or through conference networks Target audience: Managers, Practitioners, Researchers, and Public Representatives. Learnings/Take away: To illustrate system transformation, leadership and approach To introduce an implementation framework for integrated working Prioritise and identify key elements relevant to attendants Share and note experiences of how elements play out Identify solutions (facilitators and barriers) Record and feedback notes from workshop (co-produced leagacy)