NHS BNSSG - Interim Integrated Care at Home Services

NHS Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board's (the Commissioner) is commissioning Interim Integrated Care at Home (IC@H) Services. The service will develop, operate and evaluate Interim IC@H services in three localities of BNSSG over a period of 2 years. Interim IC@H services are a multi-agency approach across health, social care and VCSE partners in BNSSG, focused on people at risk of a deterioration in their health and independence that may lead to hospital admission or use of long-term care in the next 12 months. As part of our emerging local approach to neighbourhood health and care, the ICB intends to procure interim IC@H services through a single contract with a lead provider who can act as a strategic partner. The lead provider will lead and coordinate work to develop integrated systems, processes and workforce models across system partners in the three 'early implementer' localities. The target cohort is expected to include: * Older people who are becoming frail or are at risk of a deterioration in their health, wellbeing or independence. * Working age people living complex lives due to multiple disadvantage. * Working age people living with multiple conditions (including pain, depression and anxiety) whose health conditions are worsening. The provider will use a test and learn approach to identify and offer targeted, coordinated and integrated support for people in the target cohort who are: * Identified as a risk of deteriorating in the next 12 months. * Experiencing a crisis which could result in hospital admission or entry to long term care. The provider will lead the development and operation of the IC@H model and support the ICB to evaluate the impact via an iterative test and learn approach in the three localities. Specifically, this includes: * A multi-agency approach to case finding to identify a target cohort of people in the three localities. * Implementing general practice-based care coordinators in the three localities. * Building and operating effective local multi-disciplinary neighbourhood teams in the three localities. * Implementing an enhanced centralised care coordination function for people in the target cohort who are in crisis. * Co-production and engagement with people, carers and families at all stages of the programme. * Providing effective clinical, professional and operational leadership to co-design and refine the IC@H model and identify opportunities and barriers to scaling across BNSSG. * Practical change management support with a focus on culture as well as process. * Gathering data to support qualitative and quantitative evaluation of the impact of the model on people's outcomes, the experience of people and staff, and the level of return on investment for the health and care system The ICB intends to procure this service through a single contract with a lead or prime provider who will lead and co-ordinate multi-agency working across system partners for the target cohort in the 3 early implementer localities. model across existing health, social care and VCSE services in BNSSG. To deliver this contract, the provider must have access to the BNSSG registered general practice list and case records in the three localities and be able to develop an integrated approach across existing health, social care and VCSE services in BNSSG. The geographical scope of this contract is expected to cover 3 'early implementer' localities in BNSSG: South Gloucestershire, South Bristol and Weston, Worle and Villages. The estimated contract value is a total of PS4.6m for the initial 2-year contract term. The annual budget will reflect the phased implementation schedule for the three localities. The contract is expected to commence in November 2025 and end in October 2027. A 2-month design and mobilisation period has been assumed in each locality to enable sufficient time to recruit additional staff and secure appropriate clinical and professional input from all system partners. The deadline for ITT responses is 12:00 on 8th October 2025. This exercise is being managed by NHS South, Central and West Commissioning Support Unit (SCW) on behalf of the Commissioner.