Proactive not medical model of care needed, says report

Shifting care to the community will require a ‘new proactive model’ of care rather than moving a medical model into communities, according to a new NHS Confederation report.

The report, A case for neighbourhood health and care, states that though policymakers have long talked about a more ‘joined-up’, proactive care with flexibility to respond to local needs, that ‘this is not how our health and care systems operate or are experienced by communities today’.

Based on a review of literature and 14 case studies on community and neighbourhood working, the report adds that any transformation of public services must be accompanied by a more ‘fundamental transformation of relationships between statutory services and communities’.

It says the factors driving poor health and ‘the most successful responses’ sit outside the conventional reach of the NHS.

‘Not only are medical solutions to social problems unlikely to work, but there is an increasing risk of ‘moral injury’ to healthcare staff when they are asked to solve problems for which they can’t provide the answer,’ it states.

‘This is reflected in growing issues of both recruitment and retention of highly qualified and committed staff, across the health and care sectors.

‘No one agency, service or group holds the answer to these problems. What is needed is coordinated, system-wide action that spans communities, health, criminal justice, employment services, education and local government.’

It adds that the future of primary care was ‘intrinsically linked’ to the neighbourhood model and highlights the 2022 Fuller Stocktake report’s integrated neighbourhood teams model which ‘brings together previously siloed teams and professionals to do things differently to improve patient care for whole populations’.

It highlights that in some areas, the GP practice or local pharmacy may be the only community asset left and that, ‘there is significant variation in the capacity of individual practices, social prescribers and the PCNs that support them to move beyond traditional patient engagement to partnership working with communities’.

The report adds: ‘Enabling GPs and wider professionals to engage and work more proactively with their communities will require changes to how primary care services are contracted, funded and assured, to unlock capacity and optimise at-scale provision/expertise in primary care.’

The report also cautions against spending time on defining what a neighbourhood is as they can vary from a ‘few houses to a residential area of 50,000 people and above’. Instead it recommends that statutory services need to focus on ‘thinking neighbourhood’ in all they do, and taking the time to understand and engage with the local population.

Neighbourhood working and multidisciplinary teams were hailed as the way forward in the report by Lord Ara Darzi last month.

PCN clinical directors were also advised to make better use of community assets to tackle health inequalities.