Integrated Neighbourhood Teams (INTs) – what are they and why are they important?

References to Integrated Neighbourhood Teams (INTs) seem to be everywhere. In this first blog in a series, our Medical Director, Dr Natasha Curran, and our Clinical Director for Community and Care Homes, Dr Carrie Chill, a GP in south west London, discuss what they look like, what they could achieve, and why they are important for innovation."

Within healthcare, Integrated Neighbourhood Teams (INTs) bring together people and services to improve population health and wellbeing. How this integration works will vary depending on the purpose of each team, it is not one size fits all.  For example, an INT to support people living with frailty might comprise core primary care staff from general practice and district nurses from a community service provider. Community services include community nurses, community specialist nursing services, occupational therapy, community physiotherapy, speech and language therapy, some frailty services and care home support team.

In addition to general practice staff, Primary Care Networks (PCNs) also hold contracts for other clinicians working in primary care such as clinical pharmacists, mental health workers, care co-ordinators and paramedics. Community pharmacy optometry and dentistry (commissioned by NHS England) might also contribute to an INT. A different type of INT might include many of the proactive and preventative children services such as health visiting and child health surveillance.

Social care, local authority services, mental health services and voluntary organisations are also important in supporting communities at a very broad level. Voluntary sector organisations offer a range of services which help bring groups and communities together and local authorities provide a whole spectrum of wellbeing and public services such as such as weight loss, smoking cessation and sexual health services. Local authority public health services address environmental issues such as access to green space, population, parks and exercise and sports facilities, and potentially elements of employment and wellbeing.

Sounds like it might be complicated, but really INTs are about bringing together healthcare, social care and voluntary organisations who support communities in different settings. It means looking at people and services more holistically and potentially moving health services from their usual settings e.g. running a GP drop-in service in a community venue which may help build long term relationships.

INTs strengths lie in delivering proactive care as well as being able to identify deterioration and react in a timely way. They link to rapid response and urgent care services to respond to crises when they occur. Shared care plans support a patient centred response and help create a joined-up care pathway.

What populations do INTs serve?

INTs are a way of addressing health and social inequalities.  They should be data driven and should respond to the needs of the people they serve. So, an INT might serve a physical neighbourhood but could equally serve a specific community that spans a larger geographical area. The needs of rural and urban neighbourhoods may also be quite different in terms of population density, transport links and amenities. In the West Country teams might span much of a county but in London a neighbourhood could have smaller footprint than a large Primary Care Network (PCN). New Malden is a small geographical area in south west London but one which has the largest Korean community outside of Korea, a community which has particular health and social care needs such as access to mental health services that may benefit from the tailored approach offered by specific health coaches.

Are there any good examples that can bring this to life for us?

A project which spread to Battersea, south London from Westminster employs community health and wellbeing workers based on the original community wellbeing worker model from Brazil. The Commonwealth Fund’s Frugal Innovations in Health Care Delivery case study on Brazil’s Family Health Strategy links it to improvements in breastfeeding rates, a decrease in inequalities in healthcare utilisation, an increased immunization uptake and a reduction in avoidable hospitalisations. However, the impacts are debated, with this systematic review seeing benefit in child mortality alone, and others suggesting that the local density of health teams is important to the observed effects on adult health.

What could we aim to achieve? How do we know they working?

Clinicians and care staff working together and taking responsibility for bringing the right skills and resources to the person in front of you, intuitively feels like a good idea but how do we really know the projects are working?

The National Association of Primary Care's paper on INTs suggests that “savings will be non-cash releasing, but this is not an issue as what is required is capacity and health improvement.”  Its analysis suggests that INTs will improve the cost effectiveness and efficiency of NHS spending and reduce the future funding requirement driven by poor health status and demographic change by the following:

Continuity of care is important to patients and clinicians and has been demonstrated to reduce mortality and be cost effective. Over the last decade access has become a higher priority and INTs may be able to redress this balance for people living with complex health and care needs, co-morbidities and frailty who stand to benefit the most.

How might technology help?

There is technology available that will help enable INTs in case identification and case planning. There is a task in curating, evaluating and aligning the different technology systems to assist teams so that they are cost effective to communities. A key enabler is sharing data in a safe way. Technology can also play a vital role enabling teams from different organisations to work effectively together.

For example the Universal Care Plan (UCP) for London enables health and care staff including urgent care services such as 111 and 999 to view a patient’s care plan, wishes and preferences.

How about scaling?

Brilliant bottom-up projects have buy-in from those involved in them, but as we know in the business of spreading and scaling innovation, the step to the next neighbourhood, borough or ICS is a great challenge! Leadership, workforce, technology and the space to make transformation happen will be vital.

Developing the evidence base and demonstrating the cost effectiveness of projects will also help the spread and adoption of this work.  We should consider how projects can be scaled from the outset by modelling the potential cost of implementation and what factors enable successful commissioning and contracts.

Data and implementation by teams who know the local area are imperative to also ensure that scaling is not a thoughtless ‘lift and shift’ approach which assumes the ‘next neighbourhood’ is the same, so tailoring or a different set of teams will be required.

One way is learning from each other and identifying best practice. South West London recently held an event to share evolving practice and other professional organisations and INTs are learning together in a similar way e.g. physiotherapy teams looking together at fall prevention, complex paediatric services and those with learning disabilities.

How might Health Innovation Networks help the development of INTs?

We can think of several ways, such as supporting to identify and evaluate tools looking at case identification and technology assisted care planning such as an IT-assisted comprehensive geriatric assessment. There might also be a role in understanding what shared care plans are available and assistance with data sharing agreements.

Bringing teams together in communities of practice, building trust, knowledge and experience as done recently by one of our ICSs is also an area in which HINs excel, alongside building evaluation and quality improvement capacity within evolving INTs projects.

What’s next?

In our next blog we’ll be talking to Dr Minal Bhakai, GP and Director of Primary Care Transformation at NHS England about creating the conditions in which INTs can flourish and highlighting some more local examples. Later, we’ll also be exploring how to best use population health data and evaluation to further the development of INTs.