Exclusive Cornwall ICB is planning to invest £18m into integrated GP neighbourhood teams, which will include hospital consultant input for key specialties.
The strategy will see practices grouped under 16 integrated neighbourhood teams (INTs), made up of one or more practices, as well as community services, social care and the voluntary sector.
The ICB also wants to incorporate ‘secondary care input’ from hospital consultants providing advice for their particular specialty such as diabetes, respiratory conditions, cardiovascular disease or elderly medicine.
It said that a ‘distinctive feature’ of Cornwall’s INTs is the ‘integration of secondary care clinicians’ into each team, and that by including secondary care doctors, INTs can ‘reduce the need for hospital admissions’, improve patient outcomes, and deliver ‘more care closer to home’.
It said: ‘This advice at a place level will be readily available to GPs so that patients can get the right care at the right time, without the need to refer into the secondary care system which traditionally is built on a series of outpatient appointments and admissions in hospital settings that involve travel for patients.
‘There are already examples in Cornwall and Isles of Scilly where this works well – for example, hospital consultants from University Hospitals Plymouth discussing 40 diabetic patients in a morning or afternoon, providing advice for GPs with only some of these patients then needing to travel to their local GP practice or a community setting.’
According to information shared by Kernow LMC, it is planning an extra £6m per annum recurrent investment (£18m recurrently by 2027/8) into INTs.
The plan will begin with four ‘early adopter sites’ and ‘quickly’ scaled up, in a bid to reduce outpatient appointments and waiting times, according to the ICB.
Other services and ‘support’ within the INTs will be available and this will also ‘reduce the workload for general practice’, the document said.
All neighbourhood teams will use artificial intelligence to identify patients ‘most at risk of hospital admission’, with a member of the INT ‘proactively’ contacting them to check in on how they are managing their conditions, medications and individual circumstances.
The strategy also mentioned 11 primary care hubs, which provide an ‘overflow’ facility for general practice to be able to refer people ‘who do not need continuity of care’ but who do need to be seen ‘urgently by a primary care professional that day’.
Last year, Pulse revealed that the ICB had ‘committed to long term funding’ to ‘expand’ the capacity of the hubs.
The ICB said: ‘These hubs have been in operation since December 2023 and have so far seen over 16,000 people. The hubs are still increasing their capacity as new hubs are established to ensure all our population has good access to one of them and the workforce is secured with longer term contracts. In 2025 to 2026 we anticipate there will be 67,500 appointments.’
As part of the plan, it also promised to invest more in primary and community care in areas of deprivation.
‘We have been working with some of the GP practices in our highest areas of deprivation to understand their additional pressures and higher workload and how a fairer funding model would support them better,’ the ICB added.
It comes after the Government promised to ‘reform’ primary care, trialling ‘neighbourhood health centres’ which would have GPs and other community health staff ‘under one roof’. It is currently working on a new 10-year NHS plan, expected to be published in the ‘spring’.
The Government has already announced that GPs are going to be paid £20 for undertaking advice and guidance (A&G) with hospital specialists, as part of a bid to bring down the elective waiting list.
Professor Claire Fuller’s landmark review in 2022 had already recommended the creation of integrated neighbourhood teams, and last year, 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.
PCNs in Cornwall were invited by the ICB to submit proposals to help shape the strategy.
In an update to practices, Dr Stewart Smith, who chairs the general practice collaborative board, said: ‘INTs represent one of the ICB’s strategic priorities as we work to meet the Darzi principles across Cornwall and the Isles of Scilly.
‘These teams will play a role in bringing together general practice with other system colleagues to provide more coordinated and effective care for our local populations.
‘The ICB are committed to implementing INTs through a phased transformation programme over the next three years. Whilst we await more detail, the collaborative board welcomed this additional investment into primary care and the opportunity for our PCNs to help shape INTs.’
A spokesperson for Cornwall and Isles of Scilly ICB told Pulse: ‘Our integrated care system is committed to investing in Integrated Neighbourhood Teams (INTs) to deliver benefits including admission avoidance and ultimately better health outcomes for our local population.
‘Though our operating plan for 2025/26 is still being finalised, this commitment is demonstrated by our recent invitation for expressions of interest to join the first INTs.
‘At present we are working through the detail of this, including the support needed for INTs to operate effectively.
‘We see the INTs as being “loadbearing” and as such supporting general practice and the other essential community services that we all rely on to provide care where it matters.
‘We are encouraged by the enthusiasm we’ve seen from GP colleagues and are excited by the opportunities that INTs offer at place, both for the patients and communities that they serve.’
Other ICBs around the country have started overhauling their model of care, including North West London ICB where health bosses drew up plans to introduce integrated neighbourhood teams and Cambridgeshire and Peterborough ICB, where the radical overhaul is going to cost £205m.
Last month, NHS England said it is expecting to see ‘increased’ rates of school attendance for children as a result of its neighbourhood teams strategy, with special clinics being set up by GPs to help with this.
It’s an inescapable truth that we had far superior levels of integration in the NHS in 1980s-2000s, when the specious misdirection of ‘siloed’ practice began, than we have witnessed ever since the advent of Medicine designed by consultancies. The only exception being the ‘integration’ of the private sector.
We had Consultants in general practices with PCTs; it was phased out – a waste of money and specialist resources, who ended up seeing patients more appropriately dealt with by GPs and wasted valuable time commuting to practices.