What’s next for local contact tracing? A view from Oxfordshire

Since they were established in August last year, local contact tracing partnerships (LTPs) have become a key part of the national test, trace, isolate, and support response in England. As case rates of covid-19 rise again in the UK, we explore the opportunities for local authorities to further tailor their LTP response to local residents, and outline what we’re planning in Oxfordshire.

The whole of England is now covered by an LTP. These are locally developed and locally led contact tracing systems that were originally designed to pick up the one in five cases that the national Test and Trace team were unable to reach back in August 2020. Under the arrangement, cases that the national team can’t reach within 24 hours are passed to the local authority-led contact tracing system—the LTP—to follow up.

LTPs are able to use their detailed knowledge about their local population to fill in missing contact details, and employ a combination of texts, emails, phone calls, and home visits to reach cases. Once contacted, the LTP advises the local case to isolate, provides detail about local available support, and takes the names of any close contacts the case may have had while infectious. These close contacts are then passed back to national call handlers to follow up.

While there are no nationally reported data on the success of LTPs, they have been widely well received both by local populations and by NHS Test and Trace. This has been put down to a number of factors, including using a local phone number, having local staff on phones, and visiting homes who are more likely to understand their communities’ needs and speak the same languages. They are also able to tailor local support offers such as emergency food packages and prescription pick-ups, and to coordinate support payments.

At Oxfordshire County Council, we had one of the first LTPs in the South East to go-live, launching on 13 October 2020. We have now reached over 2,000 local cases that otherwise may not have been contacted. As with all LTPs, it’s a partnership. Firstly, the LTP works hand-in-glove with the national Test and Trace team to manage the local case load. Secondly, our call handlers work for the county council, with the five local district and city councils coordinating home visits, providing isolation support, and identifying additional contact details where required. Student cases are securely shared with the county’s two universities to ensure they have appropriate follow up and support. And the local Public Health England health protection team help with more complex cases and outbreaks, often working across our local NHS trusts, schools, and social care services. 

Since the LTP’s launch and the end of May, 94 per cent of all local cases were successfully reached, advised to isolate, offered support, and had any close contacts identified by either the local or national team. And we’ve recently been trying to do more to understand where we can improve. Are we more successful in reaching older or younger residents, or those living in more deprived or more affluent parts of the county? Are some residents more likely to respond to the national system than our local team, and if so, why?

To do this, we’ve analysed our own data as well as partnered with similar local authorities for peer-review sessions to learn from each other’s experiences. The data tell an interesting story. 

The disproportionate impact of covid-19 on more deprived population groups is well documented, and it’s no different in Oxfordshire. Between December 2020 and May 2021, case rates among people living in the most deprived quintile of the county were nearly double that of the least deprived, subsequently accounting for two in five cases handled by our LTP. And cases from these more deprived parts of Oxfordshire are less likely to be reached by the national team compared with other cases, with 14 per cent passed to the LTP compared with 11 per cent overall.

But then there’s also good news—our LTP is more successful in reaching these local cases from more deprived areas. Of cases referred to our LTP, over the same period we’ve subsequently completing contact tracing for 65 per cent compared with 60 per cent of cases from more affluent parts of the county. Some of these differences are explained by missing contact details—nearly one in four cases passed to our LTP are missing crucial contact information—but even accounting for this, case numbers and LTP success rates are highest among people living in the most deprived areas.

We have also looked at our local data by age and find that the numbers of LTP-managed cases are higher among the most deprived quintile across every age group analysed. The most significant differences are among adults aged 18 to 25 years and 26 to 49 years. In both age groups, over two and a half times more cases from the most deprived quintile have been managed by our LTP than any other deprivation quintile. And again, the subsequent success rates are higher than any other quintile. 

Not only are younger, more deprived adults more likely to get infected because of factors such as being unable to work from home or living in multiple occupancy households, they are also often less able to adhere to government guidance. Reasons include having caring responsibilities, insecure work, and financial hardship. This makes it even more important for these individuals to be reached by our LTP and offered support. 

What’s next for LTPs

Many LTPs have recently taken up the national offer to join a pilot programme called Local-0. Here, LTPs take cases after just one hour of the case being transferred to national Test and Trace rather than after 24 hours. The LTP handles all their local cases with none managed by the national team. Similar pilot programmes are also being explored where LTPs manage contacts as well as cases. Such approaches may be particularly appealing in areas where there are high case rates, or the national team is less successful in reaching cases. However, these programmes don’t come with additional resource and they can risk taking council staff—who often support LTPs alongside other roles—further away from their business-as-usual or other vital covid-19 work in areas like vaccination and testing. This is particularly of concern as case rates rise again meaning many local authorities are having to send a proportion of their local cases back to the national team for contact tracing because of capacity issues.

An alternative, more flexible, approach is soon to be introduced with a new national case management system called the Integrated Tracing System, or ITS. Originally planned for roll out in July but now delayed until later in the summer, ITS will allow LTPs to pick and choose which cases to handle immediately, and which to leave with the national team to try and reach for 24 hours, with decisions based on the kind of data-driven approach to contact tracing described above. This has the potential to maximise the impact of contact tracing (for example, by providing more rapid support to cases living in more deprived areas) while at the same time ensuring that local staff aren’t overwhelmed and can continue their other vital roles. 

Fifteen months after the first lockdown, local authorities will continue to play a central role in managing the impact of the latest wave of infections on their local population. From community support hubs to community testing, to outbreak management to LTPs, they will again try to balance the immediate priorities of pandemic management alongside supporting local socio-economic recovery and maintaining core services. Anything that can both support local residents and help balance local resources will make a difference, and assuming no further delays, the next steps for LTPs promise to offer just that.

Sarah Payne-Riches, public health specialty registrar, Oxford School of Public Health

Katherine Arbuthnott, public health specialty registrar, Oxford School of Public Health

Rachel Dennis, communications and media officer, Oxfordshire County Council

Parveen Gujral, senior data analyst, Oxfordshire County Council

Adam Briggs, consultant in Public Health, Oxfordshire County Council and Honorary Associate Clinical Professor, Warwick Medical School

Competing interests: AB, PG, and RD are employed by Oxfordshire County Council. AB is responsible for the Oxfordshire County Council Local Tracing Partnership and is a public health strategy advisor to the Chief Medical Advisor, NHS Test and Trace. SPR holds an honorary contract with Public Health England, to work as part of the Thames Valley health protection team