Oxfordshire worked with Public Health England and NHS Test and Trace to launch its local contact tracing service in mid October. A team of 14 call handlers drawn from Cherwell District Council and the county council provide contact tracing on behalf of all the districts. This case study is part of a series on local contact tracing.
- Contact tracing got under way in October with a team of tracers drawn from the county council and Cherwell District Council customer services teams
- District council staff had to be seconded across to the county council to comply with data-sharing rules
- Performance has been improving week-by-week, but with infection rates increasing the team is looking to develop a more intelligent and focused approach to contact tracing
Oxfordshire is home to a population of nearly 700,000. There are five districts – Oxford City, Cherwell, Vale of White Horse and South and West Oxfordshire.
The area has had lower than average infection rates throughout autumn. By the end of October around 800 cases a week were being diagnosed – just below 120 cases per 100,000.
The highest rates were seen in Cherwell and Oxford. Oxford was placed in tier two of the alert system, while the rest of the county was tier one before lockdown.
What was done
Oxfordshire worked with Public Health England and NHS Test and Trace to launch its local contact tracing service in mid October. A team of 14 call handlers drawn from Cherwell District Council and the county council provide contact tracing on behalf of all the districts.
Each day, local cases that the national team has not been able to reach and need contacting are made available to the council through PHE’s Power BI system. The data is checked for any cases without complete contact information and cross-referenced against the councils’ own records to see if extra information can be assessed.
Duplicate cases are filtered out along with cases that should not have been transferred for one reason or another and those that have told the national team that they no longer wish to be phoned. It leads to about three quarters of cases being followed up.
These cases are then allocated by a team leader to the four contact tracers on shift. The service operates seven days a week.
Cases are sent a text message or email before the contact tracers attempt to call. Three attempts are made in the first 24 hours, followed by two attempts the following 24. If by 3pm on day two no contact has been made, the team passes the case on to the “ground force” for home visits.
County Council Public Health Consultant Dr Adam Briggs, who has overseen the creation of the service, said: “It did take a lot of work to get going. There are all sorts of logistical challenges for two-tier areas. One of the issues we faced was that because of the data-sharing arrangements in place with Public Health England, our districts were not allowed to be given the authority to handle the daily downloads of test and trace records.
“It meant our district council staff could not work as contact tracers so instead they are seconded over to become county council employees for their contact tracing work.
“We also needed additional data sharing agreements between the county council and districts for passing over cases to our ground force teams. It was huge team effort to get everything done very quickly, but obviously it was an added complication that needed to be resolved before we could launch.”
The performance of the service has been improving each week and the team has so far been able to reach over 300 cases that otherwise wouldn’t have had their contacts identified or been offered support to isolate.
Dr Briggs said: “The partnership with NHS Test and Trace seems to be working. For example, we have had most success with our older and potentially more vulnerable residents. One of the challenges we face is we have a large student population and are finding that about half the cases that get passed down to us are in the 18 to 25 age group.
“We are working closely with our universities and I have asked the national team if we can re-open access to the online self-serve system for filling in close contacts for students. Nationally, all cases are initially asked to fill in the details online but once eight hours is passed that opportunity closes.
“The two universities here have good systems in place to support and contact students. Students are obviously very digitally savvy so this would be a much more productive way of running contact tracing for students and would allow us to concentrate our efforts more on the other local cases.”
Delays in the release of cases through PHE’s Power BI system has led to problems for Oxfordshire. Initially its weekend service ran from 10am to 1pm.
Dr Briggs said: “We are meant to get the Power BI downloads between 10am and 10.30am, but on a number of occasions it has come later. It’s a national problem that has meant we have had to adjust our shift patterns. We now staff the service at weekends until 3pm and we are thinking of extending it to 5pm.
“You have to be prepared to adapt. Alongside our weekly operational cell, we have a troubleshooting meeting twice a week with the team to discuss what is happening and discuss any issues, and we are in regular dialogue with the national team to feed things back.”
But one decision that was taken early and Dr Briggs believes is right was the approach to door-to-door contact tracing provided by the “ground force”.
Each of the districts has their own arrangements for who fulfils this role. Some use environmental health officers, while others rely on community wardens or staff who have been set aside to provide shielding support.
But they have all been given the same remit – making contact with the cases, providing written and verbal advice about support available to help with isolating, and asking cases to call the council to complete contact tracing. “We decided early on that the logistical and training challenges of asking our ground force to also do contact tracing didn’t outweigh any marginal gain in identifying more contacts. We’re keeping a close watch on this and are always willing to adapt our approach if we think it would help. Either way, having a ground force team definitely helps us reach cases that wouldn’t otherwise engage.”
Oxfordshire is making plans to increase the size of the contact tracing team so that it can cover the possibility of case numbers doubling over the coming weeks. It also wants to develop a new IT system to collect and record data that is more robust and allows for more flexible analyses than the Excel system currently used.
And Dr Briggs hopes that greater data analysis can pave the way for more intelligent contact tracing. “With infection rates increasing, we have to think about how we can make best use of our resources.
“That could mean filtering the cases to initially focus on those that have tested positive most recently, or changing our operational model to have different messaging, phoning, and door-knocking processes for different parts of the population who may be more likely to respond to one or other approach. I’m delighted with how things have gone so far but there are still lots of ways we can improve.”
Public Health Consultant
Oxfordshire County Council