The idea of integrated neighbourhood teams (INTs) was introduced over 18 months ago as the centrepiece of the Fuller Report.  Since then this report has gone on to become de facto national policy for general practice, and yet we are seeing little progress when it comes to the development of these teams.  Why is that?

The reason is because this is the way the NHS works.  General practice has been largely shielded from many of the issues that how the NHS operates causes (with the exception of those who worked in CCGs), but INTs provide an example of how the top down nature of the NHS and the many layers within it conspire to stifle innovation and new ways of working.

The Fuller Report introduces INTs as a concept, but without a detailed blueprint of what they are to be.  The closest it gets to a definition is stating that in neighbourhoods of 30-50,000 they are where “teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams, and domiciliary and care staff can work together to share resources and information and form multidisciplinary teams (MDTs) dedicated to improving the health and wellbeing of a local community and tackling health inequalities.”

The intention is that local areas will develop their own blueprint of an INT to match local needs, as opposed to assuming a one size fits all model will work.  This is difficult for NHS teams, now in the form of ICB teams, because they in turn are unclear of what an INT is, and so are unsure what it is they are supposed to be implementing.  Many PCNs have had the experience of asking their ICB exactly what an INT is and been unable to obtain a clear answer.  Indeed it is not uncommon for practices and PCNs to attend ICB workshops on INTs and still come out none the wiser!

But pressure for progress at the top of the ICB has been building.  ICB primary care leads are asked to report on their ‘progress on Fuller’ with INTs at the top of the list, and performance management down the line becomes increasingly heavy handed with the lack of progress.  So at this point ICB leads have started to pick anything that is happening locally with a vaguely multi-disciplinary feel and calling it ‘their’ INT, so that they can report back up the line about the progress that is being made. It may have been a pre-existing local enhanced service, or a small pilot project that a PCN was undertaking, but before you know it it is being held up as a shining example of integrated neighbourhood working.

As an example a PCN Clinical Director friend of mine was leading a local frailty project, and was surprised to discover that this is now being held up by the ICB as being at the forefront of local INT development.  Across the patch pre-existing projects have suddenly found themselves re-labelled as INTs, and INT development seems to have become more an exercise in communications than improvement.

Up and down the country huge effort is being expended feeding information and progress updates about INTs up and down the NHS line, but with relatively little support for local teams to innovate.  When I worked in a CCG this was exactly what happened, all of the time.  The ability the same group of GPs had had to innovate and implement change before we became a CCG was lost when the layers of NHS England were imposed above us.

For general practice the lessons are twofold.  One is that if anyone can turn the concept of INTs into something that will make a difference for local populations it is front line teams and not those who operate at a distance from care delivery.  If money and resources are going to be put into INTs (whatever they are), then it may be a good idea to identify for yourselves what changes might make the biggest difference locally rather than letting the opportunity be squandered. Two is that the freedom that general practice has, and its ability to act quickly, is one of its greatest strengths, and this is what will be lost if general practice ever does lose its independence and become permanently weighed down by the heavy layers of NHS bureaucracy.