Neighbourhood working what to sort out before a shared home visiting team goes live

At THC Primary Care, we provide resources for primary care network leaders. Over the past 11 years, I have worked with more than 300 primary care networks and healthcare organisations, and in this blog, I want to set out what to work through before two organisations put a shared team together from a digital perspective.

But it’s important to acknowledge that digital integration means different things depending on where you stand.

Sometimes it is working with public health, so everyone is reading one set of data, and we are all looking at the same cardiovascular disease rates rather than three slightly different versions.

Sometimes it is partnering with a trust on a home visiting team, where staff from different organisations need to get into the same patient record.

That is the one I want to focus on, where trust staff and general practice look after the same patients. This is not about passing the patient between organisations. It is seamless integration.

Start with how a visit happens today

Before designing anything new, get the people already doing home visits to walk you through what happens now, step by step, and ask which bit of tech does the work at each point.

• The request. How does a visit request come in, who does it come in to, and what system does it land in?

• Triage. Who decides whether a visit is genuinely needed, and where is that decision recorded?

• Allocation. Who picks the visit up, and how do they find out? A system, a printed list, a spreadsheet or a phone call?

• On the road. What can the clinician see once they leave the building? The full record, a read only view, or whatever they printed before they left?

• The consultation. What happens to the notes in the moment?

• Write-up. Where and when does it happen?

Be granular and keep an open mind.

Do your staff finish the write-up in the car, or drive back to the practice for a laptop? The point is to ask, rather than lift and shift the old way onto a bigger team.

Be honest too that the decision is rarely only clinical. Kitting a large visiting team out with laptops or iPads might push you over budget, but a clinician driving back to base to write up is a cost as well, just a less visible one.

What cannot be compromised is high-quality care, so the question is how do you make the budget work with no negative implication for the patient.

Map what happens now, then what it would look like with staff employed by different organisations.

That is your baseline standard operating procedure. Only then do the tools become a sensible conversation.

With that in front of you, there are six things to work through:

• A clear understanding of what is needed

• What tools you need

• Infrastructure and support

• Funding streams

• Access and governance

• Culture and adoption

A clear understanding of what is needed

The people looking after a patient need to see the same record, know a visit has been booked, and get their notes down without waiting until they are back at base.

What tools and systems do you need in place to make this happen seamlessly?

If seamless isn’t available to you, what would good look like?

(Please note, a lot of what a shared visiting team needs is not digital at all. A standard operating procedure, a rota, cover for sickness and leave, but for this blog I am focused on the digital layer.)

What tools do you need?

Once you know the process and where the gaps are, what good would look like, then we can look at tools.

If what good looks like is that the clinician spends more time talking to the patient rather than spending the conversation typing and rather using any paper records, and it works on a phone, in a car outside the house, on a connection that may not be there.

Dictation and ambient tools are built for exactly this. Lexacom, who sponsor The Business of Healthcare podcast, are one option worth looking at, but the point holds whoever you use.

Infrastructure and support

Mobile data matters here, because Wi-Fi in someone's home can be challenging, and a tool that assumes a perfect connection will fail you on the visit where you need it most. And when two organisations share a team, be clear from the start about who supports the kit, because "I thought that was your IT team" is not a plan.

Funding streams

Who pays always needs addressing. So I won’t labour the point.  When a service is shared across a trust and general practice, the cost is shared too. Is that recognised in your model? Build the case for the long run, not the first twelve months. A tool that looks expensive in year one can pay for itself several times over once you count the time it saves and the risk it removes, but never on a one year business case.

Access and governance

Here I’m thinking of Access as who can see, book the visit and write to the record, and governance is related to what the tool has to satisfy before it goes anywhere near a patient.

You will need to consider:

• Do you need a data sharing agreement, and between which organisations?

• Have you completed a DPIA, and who signs it off?

• Does the supplier hold a current DSPT submission?

• Has the supplier completed a DTAC? NHS England published an updated form on 24 February 2026, and the previous version should not be in use from 6 April 2026. The new form has around a quarter fewer questions; elements overlapping with the Medical Device Regulations have been removed, and the requirement for the named clinical safety officer to have done NHS Digital training no longer stands.

• Clinical safety runs on two standards. DCB0129 sits with the manufacturer, DCB0160 sits with you as the deploying organisation, and each side needs a named Clinical Safety Officer. NHS England has said reviews of both standards are continuing, and DTAC will be updated again when those changes land, so expect this to move.

Culture and adoption

You can sort all of the above and still fall at the last hurdle, because a tool only helps if people use it.

Every team has a range in it. The clinician who has done things the same way for years and puts up with the workaround because it is familiar. The one who wants every bit of automation going. And a group in the middle who just need to see, in their own terms, what a different way of working would give them, without being rushed.

Adoption comes down to culture, planning, and the level of support you are willing to put in place.

To conclude

Neighbourhood working asks two organisations to behave like one team, and the digital layer is where a lot of that gets decided. It is not one system that does everything. It is a set of decisions about what you need, who can see the record, how your team gets things into it, and who owns the kit in the middle.

Most of that is complicated rather than complex, which means it can be worked out. It just requires willing parties who will bring different points of view, critique honestly and still work it out together.

If you are setting up something similar, or you have already cracked it across multiple organisations, I would like to hear how you did it. You can reach me at tara@thcprimarycare.co.uk.

And if you would like to learn more about Lexacom, please visit: https://bit.ly/THCLexacom or email andrew.whiteley@lexacom.co.uk