Since the publication of the Fuller Report in May the idea of Integrated Neighbourhood Teams has come to the fore, specifically as the report indicated that Primary Care Networks would “evolve” into these new teams.  But what actually is an Integrated Neighbourhood Teams and what impact will they really have?

A helpful starting point is to consider the Integrated Neighbourhood Teams that already exist.  There are a number of different examples of these now working in practice, so what can we learn from them, their operation and their relationship with general practice?

This example from Manchester is typical in that it focusses on the bringing together and co-location of the social work and community nursing teams.  The link with general practice is less clear.  It seems a GP is the ‘locality director’ but the nature of the relationship between practices (and the PCN) and the Integrated Neighbourhood Team appears to be a voluntary one (they “work closely” together) rather than anything more formal.

Integrated Neighbourhood Teams also exist in Suffolk.  They are described here as staff working together from, “a number of different teams/ professions: social care for adults and children/families, health, police, mental health, district and borough teams, along with the voluntary sector”.  General practice are conspicuous by their absence, and in my conversation on the podcast with those behind these teams they explained that one of the things they want to work on is the relationship between the PCNs and the Integrated Neighbourhood Teams (i.e. it is not currently clear).

In Leicestershire the Integrated Neighbourhood Teams are described as operating in parallel and alongside primary care and Primary Care Networks.  The majority of care takes place, “working as individual practice or in networks (Primary Care Networks)”, but this is different to Integrated Neighbourhood Teams which are described as “multi-disciplinary teams of general practice staff, community nurses and therapists, social care staff and the voluntary sector” focussing on specific areas of care such as long term condition management and active management of at risk patients.

In East Lancashire the relationship between the Integrated Neighbourhood Team and the GP practice appears to be primarily one of the GP referring patients to the team.  GPs have been asked to share access to medical records when appropriate with health and social care organisations within the local neighbourhood team.  The way it works appears to be that a patient is assigned a single case manager whose role it is to develop and review the care plan for patients referred to the team and to “communicate with other people involved in your care and provide regular updates to your GP”.

What emerges from these examples is a pretty clear sense that Integrated Neighbourhood Teams, certainly in their current configuration, operate in parallel to general practice and Primary Care Networks, rather than as a replacement for them.  Indeed, taking the Leicestershire example, the Primary Care Network is a component of the Integrated Neighbourhood Team (one assumes it brings the practices and their shared teams together) but is clearly separate from it.

Increasingly it is looking not so much that PCNs will “evolve into” Integrated Neighbourhood Teams, but rather that they will contribute to them.  What we are probably to expect, then, are contractual specifications for PCNs as to how they need to support and enable the working of these Integrated Neighbourhood Teams, rather than a more fundamental change of PCNs.

This makes sense in that the timing for the introduction of Integrated Neighbourhood Teams in the Fuller report is April 2023 in the most deprived areas and April 2024 everywhere else, i.e. within the timeframe of the existing PCN DES (which we already know will run its course through to March 2024).  It could be that the recent update to the PCN DES anticipatory care specification (“PCNs must contribute to ICS-led conversations on the local development and implementation of anticipatory care working with other providers with whom anticipatory care will be delivered jointly”) is specifically intended so that PCNs will play their role within emerging Integrated Neighbourhood Teams.

Things may of course change, but for now it looks like Integrated Neighbourhood Teams may represent more of an opportunity for general practice to influence the deployment and effectiveness of local community teams, rather than pose any major existential threat to the future of PCNs or the independence of general practice.