Exclusive North West London (NWL) ICB has drawn up first-of-its-kind plans to introduce ‘integrated neighbourhood teams’ inspired by the Fuller Stocktake.
All NWL providers, including GP practices, are now ‘asked to put their plans in place’ to ‘enact the vision’ for integrated neighbourhood teams, according to a document presented to the board last week.
NWL ICS chair Dr Penny Dash issued the paper setting out ‘the next stages in the development of integrated neighbourhood teams’ for the area.
There will be 25 integrated neighbourhood teams, each made up of one or more PCNs and of about 100 staff members, looking after a population of 50,000 to 100,000 residents.
Providers ‘will work towards hub arrangements’ in which core services will be housed ‘behind a single reception’, creating a ‘single neighbourhood hub’ that provides ‘a range of health and care services’.
The ICB told Pulse that the development of hubs is part of ‘a longer term vision’ and that ‘at present’, it is ‘not planning for them to replace any of the GP practices in North West London’.
However, the document warned that ‘challenges remain’ in the implementation of INTs, including the boundaries of the ICB’s PCNs ‘not fully aligning to INT boundaries’.
It comes after the new Government pledged to ‘reform’ primary care, trialling ‘neighbourhood health centres’ which would have GPs and other community health staff ‘under one roof’.
And an independent investigation into the NHS, led by Lord Ara Darzi, found that neighbourhood working and multidisciplinary teams will be the way forward for the system.
The NWL plan said the hubs will all contain core services including:
- General practice
- Care navigation
- Adult social care
- Community mental health, nursing, therapies and pharmacy
- Children’s services (including antenatal and post-natal care)
- Social prescribing
- Dentistry and optometry
- Domiciliary care and health visiting
- Voluntary Community and Social Enterprise
- Public health intelligence
According to document, services will take a ‘no wrong front door’ approach for ‘all services’ which will be accessed ‘digitally, by telephony or in person’.
The document referenced Professor Claire Fuller’s landmark review from 2022, and said that integrated neighbourhood teams ‘are the vehicles for implementing’ the changes set out by Professor Fuller.
An ICB spokesperson told Pulse: ‘INTs are about connecting wider system support up and focusing on meeting the needs of a neighbourhood population.
‘We expect that general practice will have closer connections with community providers, VCS providers, social care and community health services as a result of these developments.
‘These organisations will work more closely together in prevention of ill health and management of complexity in a community setting.
‘In implementing INTs, we will be levering the resources within our system to deliver the model of care. There are no changes proposed to arrangements for GP budgets.’
Each INT will also have an ‘integrator function’, a role performed by a person or a small team, responsible for facilitating practical operations within the team, such as business intelligence, workforce and organisational development.
The ICB said it expects these ‘integrators’ to come from a primary care organisation, community health service provider or local authority and to be in place by March 2025.
Londonwide LMCs said that currently there is ‘no set model’ for the integrator role and a funding stream ‘has not yet been identified’, but it ‘has obtained reassurance’ that general practice budgets will be ring fenced and ‘alternative funding’ will be identified to support this work.
The plans were discussed during an ICB meeting last week, in which members of the public raised concerns about the future of PCNs within the plan.
One question submitted to the board said: ‘Why in this paper I cannot see the term PCN mentioned even once?
‘It would certainly make sense to me to build on these existing effectively neighbourhood teams to create this “integrated model”.
‘Although some of these would have to get together to reduce the number to 25 as you seem to want.
‘Why seemingly re-start from new which could be as good a recipe for absolute chaos leaving residents with an unsatisfactory health and care system for years?’
The ICB told Pulse that these plans are ‘not directly related’ to the controversial proposals for same-day hubs developed last year, which are currently being revised following criticism by GP leaders, and will be discussed at a meeting today.
Professor Claire Fuller’s landmark review in 2022 recommended the creation of integrated neighbourhood teams, as well as ‘single urgent care teams’ which would ‘offer their patients the care appropriate to them when they pop into their practice, contact the team or book an online appointment’.
NWL: masterfully rearranging deckchairs whilst the ship sinks.
None of this is contractual. It is all just management fantasy.
Practices should do *absolutely nothing* until core funding is sorted out.
100k patients might be about 2 square miles in NE London
But it my patch it is half of the county.
When I first became a G P partner in 1982, our health centre was purpose built, had three practices working in it, ‘our’ district nurses and health visitors were based there and easily accessible to us as we were to them, the community midwives ran joint clinics and we had a consultant clinic there weekly. There were social workers based in the building and the local mental health team had a psychiatric social worker, and nurse also based in the building. The consultant psychiatrist did a clinic once a week followed by a catch up sandwich lunch with the GPs to discuss any patients we were either looking after ourselves or involved in the the shared care. The practice was an inner city one and we cared for about 6000 patients between the three of us. All this worked but we also knew our patients and they weren’t an amorphous mass of faces and stories from a huge number. We also knew who was providing support from the various other agencies and knew them too,
so communication was swift and easy and patient centred. It’s amazing what you can do with a bit more cash in the system paying the appropriate number of people to do the work and who feel valued and relevant working within it.
JF yes can concur similar in 1990s in practices I worked at
sadly Penny Dash et al have other ideas-https://www.nhsconfed.org/people/penny-dash
The NHS hasn’t been privatised in any literal sense – it “has been commercialised and repeatedly reorganised, with competition introduced, in such a way as to create a kind of shadowing of an as-yet-unrealised private health insurance system”. With the stealthy encroachment of profit into an institution that was set up to meet basic medical needs, the NHS is being comprehensively marketised.
Remarkably, it seems some already know the outcome of Mr Streeting’s Big Conversation ….
Bet any complexity or any capacity issues for the other providers are ‘integrated’ back to the GP practice.
Inspired by the Fuller P*sstake, the Committee for Perpetual Reorganisation in partnership with the lobby group Keep Them Distracted™ conjures up the glorious vision of….integrated neighbourhood teams! Couldn’t they have spent a bit more and got PR and branding from McKinsey…MyDoc™?
Exactly this, Dr Fleming.
Interesting that the homonym “hub” has now been repurposed by Dr McKinsey Dash, just so no-one can know what is being referred to when the acute hub plans are revived.
Interesting that NWL and Dr Penny McKinsey have popped up from the woodwork to lead on the CQC, splitting GP care, and the ICB INT Brave New World.
We know that ICBs were broke(n) before they started and that currently the only hard plans are further cuts.
Interesting that Dr Penny McKinsey Dash knows so much about plans for general practice, but general practice has no knowledge or involvement in such plans ( I don’t count meaningless words such as “integration”, or “hubs” as plans).
What is clear is that in the 80s, 90s, and 2000s, we had all of those things, built by general practice with money that followed professional consequence.
What appears to be happening is the reinvention of different models, like physician associates, with unknown consultancies calling the shots without risk or accountability.
We never were in ‘silos’, but we are now. We no longer have the agency to do our jobs effectively or safely.
Fuller is no landmark report; it just gives credence to the next consultancy iteration. NWL demonstrated perfectly how general practice is now to be run.
“No wrong front door”….but at the same time – all roads lead to general practice.
And Jo is spot on, as always
If I hear the word ‘integrated’ one more time related to healthcare I think I might spontaneously combust
So we are getting the same old services but all in one building. What a waste of money reorganising. I suspect they will not have sufficient parking.
Indeed TF, and where are these mythical buildings? What, no funding for new estates? Oh it’s an ‘aspirational’ NHS 20 year plan where all disease and illness will be eradicated and prevented by this cunning plan so that there us no need for hospitals
I think we do a disservice to Government(s) by accusing them of being incompetent when that simply is not the case. This is a systemic, purposeful & long term underfunding and underinvestment in the national health service in order to create an increasingly dissatisfied general public where they can just bin it off / create a private or semi-private system.
ICBs backed by NHSE in my opinion have taken over from CCGs in leading and causing the ongoing collapse and implosion of the NHS we are all clearly currently witnessing – they should not be leading any changes by producing further destructive money wasting headline grabbing schemes and following the Fairy-tale Fuller Fantasy but facing a deep dive investigation into their record breaking abject incompetence and what criteria was used to place some of this individuals in these positions in the first place. .