Neighbourhoods can be a frustrating concept.  Noone seems to be able to define what they are, and they have the feel of the latest initiative, one that will inevitably come and then go, like so many of its predecessors.  Given this, why should PCNs and practice engage with neighbourhoods?

It is an important question.  Too often local areas jump into what neighbourhoods should be doing (risk stratification etc), without taking the time to articulate why the work is important for general practice in the first place.  I understand the frustration with yet another new concept coming along, but I think there are four reasons why practices and PCNs do need to take neighbourhoods seriously.

1. To join up care for the local population. The frustration of many practices for many years now has been the increasing distance between themselves and community teams such as district nurses and community midwives.  The opportunity that neighbourhoods presents is to bring back those linkages, and ensure all of the local community service provision is joined up.

At present the scope of influence of practices and PCNs is very much limited to the work of the practices themselves.  Neighbourhoods provide an opportunity to shape how all of the services working in the community can operate to deliver the best possible outcomes for the local population.

2. To shape service delivery models. Too often in recent years practices have been on the receiving end of centrally defined enhanced service specification that they know are not going to achieve the outcomes that are being sought for their own patients.  These one-size-fits-all specifications fail to take into account the nuances of the local care homes, or local population groups, or whatever it is that is specific to the local area.

The opportunity of neighbourhoods is not only to be able to join up care delivery across providers but also to design and tailor service delivery models to the needs of the local population.  The whole point of neighbourhoods is enabling those front-line staff that best understand the needs of their population to create the service models that will have the biggest impact.

Just as a side note on this, not everywhere seems to have grasped this yet.  If your local ICB are still pushing one-size-fits-specifications to be implemented across all the emerging local neighbourhoods then do push back.  Establishing the freedom and autonomy of each neighbourhood to design its own care delivery models is an important first step that needs to be taken as early as possible.

3. To ensure general practice leads the work. Like them or not, neighbourhoods are coming, and GP practices and PCNs are going to be part of them.  The choice is either to engage early and establish the leadership role that general practice should be playing within them, or to ignore them and let others take up the leadership mantle.

Unsurprisingly, community trusts, mental health trusts, acute trust and councils are all very keen to play a leading role in neighbourhoods.  If practices and PCNs choose not to engage then there are plenty of others who will.  This will result in others controlling how the neighbourhood works and (importantly) how resources are deployed, with potentially hugely negative implications for general practice.

4. To shape the shift from hospitals to communities. Neighbourhoods are being established as a vehicle to enable the government’s promised shift of services from acute to community.  PCNs and practices need to be at the forefront of their development to prevent a continuation of the unfunded and unthought through shedding of activity by hospitals and turn it into an opportunity to create a prosperous future for general practice.

It very much feels like the future of general practice will be inextricably linked to neighbourhoods and how they develop.  This means the stakes feel too high for them to simply be ignored, and the sensible move right now is to take an active role in shaping them.