This is one of those questions that you feel like you really ought to know the answer to, but I am finding it very difficult to pin down exactly what an integrated neighbourhood team is.

All of the presentations I have seen about integrated neighbourhood teams outline their aims rather than what they are.  I find this unhelpful because while it might describe the problem they are trying to solve it does not actually help me understand what they are.  What I am trying to understand is who is in the team? Who leads the team? Who does the team report to?  Who sets the work programme for the team? Where does the funding for the team come from? What is its relationship to the PCN?  These are the questions I struggle to get answers to.

Even the aims of these teams seem to vary somewhat, with (for example) some places claiming they will improve access to primary and community care for local citizens and others stating they will keep people well and out of hospital.  If each area is coming up with its own definition of what they will achieve it already seems highly unlikely that what they are will be consistent across the country.

Maybe the place to start is the Fuller Report where they were first introduced, as the “heart of the new vision for integrating primary care” (p6).  Despite their proposed importance, the report does not explicitly define what an integrated neighbourhood team is.  The closest it gets is stating that in neighbourhoods of 30-50,000 “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.”

I am not sure that clears it up for me.  I remain uncertain whether an integrated care team is a concept that is designed for local interpretation (and so will result in a whole range of different manifestations) or whether it is something more tangible that at some point in the future we will all be able to look at and immediately recognise as being an integrated neighbourhood team.  If it is the former surely that should be explicit, and surely each ICS would then be clearer on its own definition.

Here is what I am most uncertain about.  Are integrated neighbourhood teams supposed to take on the whole gamut of services that each of the member teams carry out?  So by that I mean if we are bringing primary care, social care, community care (etc) together does that mean we are bringing all of the work they do together (i.e. those services in totality)?  Or does it mean we are bringing work on the edges of each of their core functions together where there is overlap between them (e.g. individuals with multiple long term conditions, requiring community services, with social care needs)?

If the answer is the latter (and I remain unconvinced that there is consistency on this across ICSs) then it means the work of these teams is in addition to existing work.  We have the core work that each team is doing, and now we have the additional ‘joined-up’ work that is the remit of this new integrated neighbourhood team.  I understand the principle that by doing this additional joined up work together the overall work in the system may fall, e.g. less exacerbations of long term conditions, but there is no immediate reduction in the core function of the participating members of these new teams.

This would mean that the work in integrated neighbourhood teams is in addition to the day job for team members.  But what I haven’t seen is any significant funding streams for these new teams, so what am I missing?  Are PCNs the existing significant funding stream?  Is this what “evolving” PCNs into integrated neighbourhood teams means?

Integrated neighbourhood teams still feel conceptual rather than tangible to me.  Whilst at a national level I understand the desire to stimulate rather than stifle local innovation and therefore why you might start with something conceptual, what I don’t understand is the reticence to define what they actually are at a local level.  It feels like what integrated neighbourhood teams are and how they work will be a big deal for general practice in the future, and so it seems entirely reasonable that at this point we should be pushing for much clearer local definitions.