Why are integrated neighbourhood teams important?

The National Association of Primary Care (NAPC) has looked at how to make integrated neighbourhood teams work. Dr Minesh Patel, GP and NAPC board member explains more

Once again general practice is being asked to carry a greater financial burden and lead the NHS to richer pastures through the development of integrated neighbourhood teams (INTs). At my most exhausted it fills me with dread that further demands will be placed on my already overstretched self and colleagues. In moments of calm I wonder, what if? What would an INT need to be that would return joy and meaning to my working day and improve the health of the population?

If I and my colleagues felt well supported in the development process for an INT and were given the time and freedom to engage in building a real neighbourhood team that knew our population well, were able to meet their needs with less bureaucracy and with confidence that those needs were met consistently, freeing us of the fallout of ‘failure demand’ then that is something I could sign up to.

I would welcome being part of a team of professionals who know each other, understand each other’s roles and where the focus is on the patient and the local population’s needs rather than on the execution of tasks. This would shortcut much of complexity and “taskification” of roles that downplays professional judgement, making for less rewarding work, poorer outcomes and higher costs.

With my positive hat on, general practice, the only part of the health service offering cradle to grave care for a registered population, should be at the forefront of leading in the development of INTs. Developing a progressively more joined up approach to meeting our communities’ needs can only be a good thing for the population and all the professionals working within them.

What is an integrated neighbourhood team (INT)?

At present, the headline NHS objectives are being described as a shift from hospital to home, treatment to prevention and analogue to digital. INTs are supposedly at the heart of plans to deliver this.

These three objectives are mutually dependent and connected by four functions:

• creating health
• preventing ill health
• reversing, halting or slowing the progression of disease
• avoiding the unnecessary escalation of place of care.

With 90% of our sense of health and well-being coming from wider determinants of health outside of healthcare, the creating health function is critical in supporting people staying well as advocates of their own health and well-being. This is essentially a community-led function which INTs should appreciate the value of but are not responsible for.

Preventing ill health, disease ‘management’ and avoiding unnecessary escalation of care are familiar to us in general practice and the multitude of teams in the community. They are the bread and butter of an INT.

On this basis, an integrated neighbourhood team should therefore be a community-based watchful group of health and care colleagues, who are working together to deliver coordinated support and care tailored to the health and wellbeing needs of a defined population 

What’s our role as GPs?

Our continuous knowledge of individual patients and the needs of communities in which we work means that we have an important part to play in building relationships with the many health and care professionals working within our communities, leading and shaping how INTs work and, identifying local priorities. We need to be open to working differently to de-layer care, reduce bureaucracy and make everybody’s work more effective. INTs need to be highly functioning teams which have shared objectives, meet regularly, work closely together and evaluate their work together.

General practice has historically demonstrated that it can turn on a pin, adapt to immediate needs and plan and act for the future in the best interests of our patients. Through primary care networks, we should be an anchor-point for neighbourhood care that can focus on local needs.

For this to happen, we need full commitment from commissioners to support frontline staff in their day jobs to make this happen.

We know from international examples, that a focus on quality improvement has a much greater impact on outcomes and professional experience, recruitment and retention.

If INTs are to thrive then our populations need thriving general practice with a stable and happy workforce at the heart of them.

Conclusion

INTs are now the direction of travel to bring care closer to home, have a strong focus on prevention and adapt to and embrace the digital age of healthcare. I welcome the improvement to my professional working day that they could bring. We need to invest trust, time and money into frontline primary care in the knowledge that every £1 spent delivers £14 of value to the economy. Real effective change takes time. Trust GPs and back them to lead this change and the right changes will happen.