Afsana Bhuiya is a portfolio GP, and Clinical Lead for Neighbourhood and Inequalities Barnet, North Central London Integrated Care Board.
Seher Kayikci is a Senior Public Health Strategist, Barnet Council.
Fahad M Iqbal is a GP Trainee, Barnet VTS, and an Honorary Clinical Research Fellow, Imperial College London.
Integrated neighbourhoods (INs), represent a model of hyper-local community based care through collaborative working between healthcare providers, social care providers and increasingly voluntary/non-statutory organisations. They aim to improve continuity of care, preventative health as well as improve capacity and demand flows in primary care and the wider system. The Fuller Stocktake Report (2022)1 stated with the right support INs would be running in the most deprived areas by April 2023 with universal coverage the following year. Yet, in 2024, widespread adoption remains limited. It is evident that operational enablers such as dedicated resources and staffing; the absence of a unifying definition for INs2; and overwhelming fiscal challenges at the ICS level3 has hindered adoption.
Defining INs remains a challenge…the primary goal is consistent: improving the health and wellbeing of residents and service users
Defining INs remains a challenge. Various reports have attempted to outline their scope, the primary goal is consistent: improving the health and wellbeing of residents and service users. Through scoping the literature and undertaking broad stakeholder engagement, an IN framework was developed locally, consisting of several key domains.
The foremost is the ‘host organisation’, responsible for holding the initiative together; ‘enabling factors’,such as leadership and pooled budget and the ‘core workforce team’, enabling the partnership to integrate and deliver care that was set out in the vision. The ‘core areas of work’ domain encompasses prevention, care coordination to health promotion- the areas an IN can deliver significant impact.
Bridging the gaps in care
Funding was secured for 12 months to support and evaluate IN models across multiple PCN sites. The pilot outputs will be central to robust business case development. In early 2024, four IN pilots were launched and aimed at delivering tailored services under specific budgets. Despite their diverse approaches, they all share a common goal: to improve patient outcomes in an area of unmet need.
The services being piloted include increasing digital health knowledge in patients; holistic proactive reviews for patients who cannot leave their homes; and a one-stop service for holistic care for patients with learning difficulties. Each pilot site provides a service unique to their population needs and works to improve prevention, case finding, care coordination and personalised care.
How do we evaluate?
Evaluating such diverse services presents challenges. However, through existing validated evaluation frameworks, we attempt to collate joint outcomes across the following pertinent areas using standardised measures.
These include:
- User/patient experience and involvement
- IN teams partnership development
- Health inequality reduction
- Preventive, coordinated, and personalised care
Learning from the Field
There is clear enthusiasm among healthcare professionals and non-clinical staff to collaborate within integrated teams
There is clear enthusiasm among healthcare professionals and non-clinical staff to collaborate within integrated teams. Early results show improved teamwork across services, with team members gaining new skills as a result. This shared sense of purpose is energising teams and breaking down traditional silos.
Patients are responding well to the extra time and attention they are receiving. They are becoming more aware of the community services available to them, and in some cases, carers of patients are also benefiting from better signposting to support services. Additionally, both providers and patients appreciate the streamlined approach, which reduces the need to repeat information across different services.
There are also some important challenges. One major issue is balancing the delivery of new services alongside delivery of usual care, which can slow down implementation and hinder data capture. Some pilots have adapted their delivery models to improve uptake and engagement from both patients and staff. Others have encountered unintended consequences, such as increased demand on downstream services due to proactive case finding and referrals, leading to capacity strain.
What’s Next?
The monitoring of the pilots, gathering data and analysing it remain central to this programme of work. There is a strong commitment to sharing the learnings with the wider health and care community. There has been wider linking into share and learn IN communities. In the coming months, the focus is on reporting the evaluation outcomes to inform future IN development and wider NHS implementation.
References
1. Fuller C. Next steps for integrating primary care: Fuller stocktake report. NHS England; 2022 https://www.england.nhs.uk/publication/next-steps-for-integrating-primary-care-fuller-stocktake-report/
2. NHS Confederation. Working better together in neighbourhoods; 2024 https://www.nhsconfed.org/publications/working-better-together-neighbourhoods
3. Bliss A, Williamson S, Alayo L. The state of integrated care systems 2023/24: tackling today while building for tomorrow. NHS Confederation; 2024 https://www.nhsconfed.org/publications/state-integrated-care-systems-202324
Featured Photo by Vardan Papikyan on Unsplash
