The new government is a fan of “neighbourhoods”.  They continually talk about how the NHS will become a “neighbourhood health service”.  A few weeks ago I considered the potential impact on practices and PCNs of neighbourhoods, based on the NHS Confederation’s report on the same.  But now some more concrete proposals have emerged.

North West London ICB have published a Board Paper entitled “Development of Integrated Neighbourhood Teams in North West London”, which outlines its plan to put these teams in place over the next few years.  This is the first of its type that we have seen, and so what can we learn about the potential impact of these teams on general practice and PCNs?

Before we get into that we should bear in mind that this is the same ICB that wanted to mandate the introduction of same-day access hubs for urgent primary care appointments separate from GP practices, and only backtracked in the face of significant pubic and professional resistance to the plan.  So this is not an ICB that has the needs of general practice anywhere near the forefront of its thinking.

As with many NHS Board papers, it is not easy to distil exactly what is intended.  The Integrated Neighbourhood Teams are apparently an alignment (whatever that means) of what are termed “core services” around geographical neighbourhoods.  These core services include general practice, along with mental health, community nursing, social care, health visiting and a whole range of other services, with the expectation that there will be over 100 professionals working in each team.

It appears that these teams won’t become organisations in their own right but will have a “dedicated integrator function” that will be a person or small team from one organisation (either a primary care organisation, community health provider or Local Authority) working with all such teams in each place area.  These are expected to be in place by March next year.

I don’t know the at-scale general practice set up in NW London, but it seems there are very few primary care organisations across the country with the capacity to take on this integration function.  This in turn means that ultimately control of neighbourhood teams will lie outside of primary care, which could have huge implications for the future independence of the service, especially if the collaboration of these teams turns into something more formal in future years.

The ambition of the plan is then to have population health management, interoperable IT and an estates plan allowing single neighbourhood hubs to be in place by 2026, joint workforce planning and co-location by 2027, and then shared budgets and integrated funding streams by 2029.

What the plan does not explain is how independent organisations (like GP practices) and their staff will function as a single team.  The responsibility for this seems to lie with the integrator function, and organisations are instructed to create plans to “enact the vision of INTs” and align operational teams to neighbourhoods, but these levers on their own seem insufficient to create what is envisioned.

The document recognises (but does not seem overly concerned by) the fact that PCN boundaries do not align to the INT boundaries.  While in previous national documents the onus has always been on community services to ensure they align with PCN boundaries, the new focus on neighbourhoods makes this much more unlikely. It is hard to envisage a future where PCN boundaries will not have to flex to accommodate recognised local authority/community services neighbourhoods.

The model also appears to lack any significant additional funding.  Dr Joe McManners explained very eloquently in a recent podcast that investing in neighbourhoods will not make the NHS cheaper, but will prevent it from getting worse in the future.  There is no invest to save business case that can fund these teams.  But getting these teams to work does require investment and an element of double running at least in the short term, yet in North West London there is no additional funding provided even for the pivotal integrator function.  The risk, of course, is that funding for this is taken from the core teams themselves, which in turn will simply serve to make these services worse.

The danger is that neighbourhood teams, as the flavour of the day, will be imposed (like in NW London) without the required investment, incentives and support to make them effective.  The government has hinted at additional funding for primary and community care, but we need to see it before embarking on this neighbourhood journey which otherwise seems destined to fail.