Objectives To develop, test, validate and implement a system dynamics model to simulate the pandemic progress and the impact of various interventions on viral spread, healthcare utilisation and demand in secondary care. Design We adopted the system dynamics model incorporating susceptible, exposed, infection and recovery framework to simulate the progress of the pandemic and how the interventions for the COVID-19 response influence the outcomes with a focus on secondary care. Setting This study was carried out covering all the local health systems in Southeast of England with a catchment population of six million with a specific focus on Kent and Medway system. Participants Six local health systems in Southeast of England using Kent and Medway as a case study. Interventions Short to medium ‘what if’ scenarios incorporating human behaviour, non-pharmaceutical interventions and medical interventions were tested using the model with regular and continuous feedback of the model results to the local health system leaders for monitoring, planning and rapid response as needed. Main outcome measures Daily output from the model which included number infected in the population, hospital admissions needing COVID-19 care, occupied general beds, continuous positive airway pressure beds, intensive care beds, hospital discharge pathways and deaths. Results We successfully implemented a regional series of models based on the local population needs which were used in healthcare planning as part of the pandemic response. Conclusions In this study, we have demonstrated the utility of system dynamics modelling incorporating local intelligence and collaborative working during the pandemic to respond rapidly and take decisions to protect the population. This led to strengthened cooperation among partners and ensured that the local population healthcare needs were met.

Health checks aim to improve the health of the population by identifying individuals with risk factors earlier and intervening to prevent disease. The role of commissioners is to ensure health checks provide as much benefit as possible for taxpayer funds invested into them. As such, evidence of the potential impacts of different commissioning choices is beneficial in this decision-making process. System dynamics modelling can be used to provide this evidence by modelling the health check programme using a pre-existing cohort model of a given population. This modelling considers local data, literature findings, and stakeholder views, from which nine different scenarios of a local health check programme have been tested. These scenarios found that extending the duration of health checks to 20 years and improving treatment uptake for those with high blood pressure or high cholesterol reduced rates of cardiovascular disease, improved healthy life expectancy and reduced years lived in ill health. In contrast, improving attendance in the most deprived quintile of the population made very little change to the health of the population overall, although a larger effect was observed in the most deprived areas. These findings helped guide local commissioning decisions by showing the long-term impact of different health check scenarios.

Cancer patients diagnosed following an emergency presentation have poorer outcomes. We explore whether practice characteristics are associated with differences in the proportion of emergency presentations. Univariable and multivariable logistic regression models were fitted to investigate the relationships between 2017–18 emergency cancer presentations at practice level in England and access and continuity in primary care, trust in healthcare professionals, 2-week-wait (2WW) referrals, quality and outcomes framework (QOF) achievements and socio-demographic factors (age, gender and deprivation). Our analysis using comprehensive nationwide data found that the following practice level factors have significant associations with a lower proportion of emergency diagnosis of cancer: increased trust and confidence in the practice healthcare professionals; higher 2WW referral and conversion rate; higher total practice QOF score and higher satisfaction with appointment times or higher proportion able to see preferred GP. Our results also show that practices in more deprived areas are significantly associated with a higher proportion of emergency diagnoses of cancer. Regional cancer networks should focus their efforts in increasing both the quantity and appropriateness of 2WW referrals from primary care. In addition, primary care clinicians should be supported to undertake high quality consultations, thus building trust with patients and ensuring continuity of care.