What is an Integrated Neighbourhood Team, and where do we start?

At THC Primary Care, we create resources to support primary care leaders.

One of our websites' most frequently searched questions is what is an Integrated Neighbourhood Team?

I have been reluctant to write about this because I do not have a definitive answer, however, I can share my thought process and the approach I have been taking.

In this blog, we provide:

1️⃣ A look back at a 10-year national commitment to integrated working

2️⃣ Provide examples of what your integrated team could look like

3️⃣ A framework to describe the four levels of integrated working

4️⃣ 10 known factors influencing the future of healthcare

5️⃣ Four further considerations to help you integrate more services

Let's jump in!

In May 2022, The next steps for integrating primary care: Fuller stocktake report was published and reintroduced us to this concept. I say reintroduced us because:

In 2013, NHS England signed up to a series of commitments on how we will support local areas in delivering integrated care and support in the first-ever system-wide ‘shared commitment’.

 The 2014 NHS Five Year Forward View aimed to enhance collaboration between general practices, promoting partnerships with community health services, hospitals, and social care.

This involved the development of new care models, such as multispecialty community providers (MCPs) and primary and acute care systems (PACS), to integrate services and improve healthcare for local populations.

The 2016 General Practice Forward View introduced a voluntary MCP contract to integrate general practice with broader healthcare services, promoting collaborative efforts among GPs across practices for extended access.

In 2017, the Next Steps on the Five Year Forward View aimed to 'encourage' practices to collaborate in networks serving 30,000 to 50,000 patients, emphasising the benefits of larger-scale models for employing a diverse range of staff without mandating service co-location.

In 2019, NHSE published the PCN Maturity Matrix, which can be found below.

The matrix was designed to support network leaders, working in collaboration with systems, places and other local leaders within neighbourhoods, covering five main domains.

➡️ Leadership planning and partnerships

➡️ Use of data and population health management

➡️ Integrating care

➡️ Managing resources

➡️ Working in partnership with people and resources

The goal:

🎯 PCN leaders are fully participating in the decision-making at the system and relevant place levels of the ICS/ICB.

🎯 Fully interoperable IT, workforce and estates across the PCN.

🎯 Integrated working with local Voluntary, Community and Social Enterprise (VCSE) organisations as part of the wider network.

The vision for integrated working at a national level is set, but PCNs can not do this alone. When looking at the maturity matrix, also presented is the role of the system and leaders at this level, ensuring:

A . Mechanisms are in place to ensure effective representation of all PCNs at the system level.

B . Analytical support and population health management tools are made available for PCNs to support care design activities.

C. Continued development of partnerships across primary care, community services, social care, mental health, the voluntary sector and secondary care with workforce sharing protocols in place.

D. Community assets and partnerships developed by PCNs are being connected in to strategic planning at place and system level.

The above references are just a sample of the increasing direction of travel. There are many more.

The Fuller Stocktake is an important document, as it sets the direction for future policy and a vision for integrated Primary Care. When Claire Fuller authored this report, she was CEO (Designate) of Surrey Heartlands Integrated Care System.

Claire is now the Medical Director for Primary Care at NHS England. This document was signed by the 42 Chief Executives of the Integrated Care Systems, demonstrating their commitment to enabling change.

The Fuller Stocktake described Integrated Neighbourhood Teams as:

'A healthcare team that brings together a variety of healthcare professionals and organisations in order to provide comprehensive care to patients’.

Underpinned by the following principles ⬇️

1️⃣ Streamlining access to care and advice for people who get ill but only use health services infrequently: providing them with much more choice about how they access care and ensuring care is always available in their community when they need it.

2️⃣ Providing more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs, including, but not limited to, those with multiple long-term conditions.

3️⃣ Helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention.

The document, whilst aiming not to be prescriptive, does not suggest an Integrated Neighbourhood Team is 1 team, but it is the formation of ‘teams of teams’ and also highlights that many networks are already collaborating with organisations beyond their practices.

It’s worth noting the principles of integrated working may be simple on the surface, but the seasoned leader understands the intricacies of working across boundaries that pull on different commissioning pathways, timeframes, and organisational cultures.

 For example, you may:

🤝 Be working with a third-sector company to support social prescribing.

🤝 Have good links with community organisations to support your vaccination campaign.

🤝 Have a service that includes staff working from a practice alongside colleagues from secondary and/or community care, funded via the ICB.

🤝 Simply know who to call in your local authority or business community to cascade patient information quickly.

These all fall on the spectrum of integrated working and integrated teams of teams.

It's important to note that Dr Doyle also clarified that PCNs would not be replaced by integrated neighbourhood teams (INTs).

Dr Doyle explained: ‘I think [INTs] are something completely different. At the moment, an INT describes the way all the teams offering services to a defined community in a neighbourhood work together to make that as seamless as possible.

‘I think PCNs are the general practice component of those INTs, but there are community services, there are end-of-life services and social care services, mental health services and a whole range of other teams who need to work in an integrated way with PCNs and general practice to deliver seamless services to our population.’

Source: Pulse

When thinking about integrated neighbourhood teams, it may be helpful to consider where you are regarding the four levels of integrated working in the simplest of terms.

This involves collaboration among individual general practices, fostering partnerships, delivering contracts, and sharing staff and premises to improve coordination and delivery of primary care services. This is the foundation of your primary care network.

This is where Primary Care Network leaders are banding together to ensure their collective voice is heard at the place and neighbourhood level.

This collaboration extends beyond individual practices to include partnerships with broader community health services. Social prescribing should be a perfect example of this with PCNs, using their social prescribing additional roles reimbursement scheme funds to fund established services.

This level of collaboration focuses on integrating primary care with hospital and social care services and will likely need ICB-level funding to bring money to organisations to truly work collaboratively; otherwise, it rests on the shoulders of a few, making any integrated working extremely unsustainable.

Many feel there is a degree of uncertainty when it comes to PCNs, and this prohibits them from moving forward, but what we do know, with or without the DES, is:

📍 There is a declining number of GP Partners

📍 The GMC’s National Training Survey 2023 found that two-thirds (66%) of trainees and over half (52%) of trainers are at high or moderate risk of burnout and Prior to this, a BMA survey found in 2020 that one-third of its respondents were burned out.

📍 Patients are living longer

📍 People with long-term conditions now account for about 50 per cent of all GP appointments (source)

📍 We all want access to products and services quickly

📍 20% of patients can result in 80% of the workload

📍 We need to create an environment that attracts and retains our workforce differently from what we are doing now

📍 Technology will become more advanced

📍 Many premises are not fit for purpose, inviting us to rethink how and where care is delivered.

📍 Medicines are the most common health intervention in the world today and represent the second largest spend in the NHS

📍 Prevention is cheaper than the cure

Again, this only represents a sample of the known challenges. You will be aware of many more that you can add to this list.

These are shared challenges and it makes sense to try and tackle these together.

This may be controversial, but I wouldn't focus on what we call it.

1️⃣ Start with understanding the stage of maturity of your network.

Use my four levels of integrated working highlighted below and described above or use the NHS PCN maturity matrix.

Level 1: Between General Practices

Level 2: Networks collaborating with networks

Level 3: Primary Care Networks and Wider Community Health Services

Level 4: Primary Care Networks and Hospital/Social Care Services

If you are at level 1. This is okay, and focus on getting your house in order.

For those of you who feel the foundations are firmly in place, keep reading ⬇️.

2️⃣ Build on what you already have.

While many PCNs may not have defined integrated neighbourhood teams, I encourage networks to look a little deeper and review their current partnerships.

You may already have a regular forum or working group you can build on.

I know of a PCN looking to strengthen its frailty provision and was quickly able to list a wide range of organisations and people they could collaborate with.

In many respects, they were already working together, but there was room for improvement.
 

In another PCN, they were looking to improve the coordination for the ward rounds, which are part of the advanced care in care homes service specification.

They have been struggling to recruit a care coordinator and are now looking into a part-funded role using a member of the care home team.

These conversations were born out of gaps in services, inefficiencies, frustrations and a lack of understanding of where each party was coming from. They did not sit down and say we wanted to build an integrated neighbourhood team.

🎯 Where are we already collaborating beyond our practices? Why did we choose to do this, what is working well, and where are their areas for development/ improvement?

3️⃣ Look for best practice

One thing the healthcare sector does well is share the good, bad and the ugly.

We are not walking a path others have not tried before, and while the challenges are plentiful, different professions and organisations can work together to deliver more joined-up care.

As a seasoned leader, you are already acutely aware that it’s not a simple drag and drop of one idea from one area into another, but learning from others will help you sow some seeds.

🎯 Where could you go to access new ideas and lessons learnt?

4️⃣ Seek Clarity

In your next strategic planning meeting or protected learning time session, along with taking some of the other considerations presented in this blog, I would also be asking:

🅰️ What is the problem we are trying to solve ( or chip away at )?

🅱️ Data and Technology

You will also need to ⬇️.

Identify key people of influence.

To make these new or developing partnerships a reality, you will need key people of influence to drive this forward.

All camps will need passionate and visionary individuals who can sign off on financial decisions and influence pathways.

All camps will also need implementers. These are the people who make things happen, are excellent at communication and understand the logistics and operational elements that need to be in place.

One party will inevitably lead, but you need a steering group to make things happen on all sides.

Tara and Team THC provide project and network management and training to Primary Care Networks. Between our training programmes, facilitation and interim network programmes, we have now supported over 120 PCNs.

Tara has an MBA in Healthcare Leadership and Management, is published in the London Journal of Primary Care, is the author of over 200 blogs, and also hosts The Business of Healthcare Podcast.

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