What makes integrated neighbourhood teams work?

Across the UK, health systems are increasingly shifting towards more integrated, community-based care closer to home. You might hear this described as neighbourhood health, care closer to home or something different depending on where you are. While the terminology varies, the underlying ambition is the same: care that is more integrated, holistic and rooted in the community.

Integrated, neighbourhood-based teams are key to this approach. They bring together people from across health and social care and other parts of the wider system to provide coordinated support for people in their communities.

The NHS England report Next steps for integrating primary care sets out how integrated neighbourhood teams can support more joined-up, personalised and preventative care. 

This approach is particularly relevant for people living with cancer. 

Many people are now living with cancer for longer, often with varying and complex needs. 70% have at least one other long-term condition. Unfortunately, we often hear that support is either too reactive, fragmented or missing altogether.

The hope is that these teams shape support and care around the needs of the individual rather than rigid organisational structures and silos.

The approach underpinning these teams has evolved and expanded over many decades into what is now neighbourhood population health. The ambition is not only to provide co-ordinated care for people with complex needs within a defined neighbourhood, but also to take a more proactive and preventative approach for the wider population.

In some places, these teams, or models that resemble them, have existed for many years. However, their terminology, design and function vary, shaped by local context and developed over time. The policy ambition in both England and Northern Ireland is to make INTs the default approach underpinning neighbourhood health.

But what do we know about how these teams work? This is the question we have set ourselves in a new project on the neighbourhood health workforce.

Our project will explore the factors that enable or undermine effective teams and integrated working.

We’ll be exploring how people experience these factors and address them in everyday practice, drawing out relevant and useful insights for teams. We’ll look at the challenges of bringing different organisational cultures together. We’ll also touch on how these teams access additional knowledge and expertise for conditions like cancer.

We’re several months into our project. Through conversations with a number of people, including focus groups with health and care professionals, what’s come through loud and clear is the variation in the make-up of integrated, neighbourhood teams. This is perhaps unsurprising. In some neighbourhoods, INT models have grown and developed long before any national mandate, alongside other programmes and approaches to neighbourhood working.

One individual referred to different ‘layers’ of INTs, reflecting different designs, configurations, and degrees of integration, and how INTs sit within the wider neighbourhood health landscape. Crucially, these aren’t necessarily a hierarchy of how advanced a model is, but different interpretations shaped by local conditions and circumstances.

It’s been interesting talking to people who are quite far along in developing these models and others who recognise there is still a long way to go in their area.

But neighbourhood teams should not be expected to jump straight to transformation as they take shape.

The West Suffolk Buurtzorg example illustrates the challenges of implementing an ambitious model when the relationships, capabilities and support needed to sustain it have not yet developed. It highlights the importance of a test-and-learn approach to developing new ways of working.

One of the individuals we spoke to highlighted the distinction between a genuinely transformational way of working and simply doing existing work more efficiently. There is a risk that incremental improvements are mistaken for transformation.

“You grease the wheels of doing the same stuff you've always done, still doing the same stuff but in a faster and smarter kind of way…the problem is that it doesn't give you the incentive to be truly transformation in your approach.”

Another key theme that keeps coming up in both the literature and our conversations is that relational and cultural factors are just as important as the structures that are put in place for integration. This is particularly important when building teams made up of people who work across different organisations, sectors or ways of working.

From our own conversations, we have heard how vital it is to invest in, and prioritise, cultural development on an ongoing basis. This can help people understand each other’s roles and perspectives, how they like to work, and the language and approaches they use.

Recent UK research into integrated neighbourhood teams also highlights the importance of strong working relationships based on trust and mutual respect, as well as clarity about roles and responsibilities. Integration is therefore a continuing and open-ended process that needs to be nurtured over time if teams are to sustain and adapt their ways of working.

Integrator functions, which connect different organisations and professionals or co-ordinate activity, can play an important role in supporting this ongoing collaborative work. Read more in PPL and the NHS Alliance’s Towards a Model Neighbourhood report on implementing neighbourhood health.

We also heard that people working in these teams need to be empowered to act on their own initiative and make decisions about how best to get things done. Without this, there is a risk that rigidly defined processes can disempower staff and constrain their ability to respond to the needs of the people and communities they are working with.

“We've made our health and care system almost systematically passive aggressive. Human interaction has been replaced with processes… people literally don't have the dignity or the kind of professional ability to do what they should do as professionals.”

Through this work, we hope to build shared understanding and learning, and to support the wider conversation about how these teams develop and spread. To do this, we are speaking with people who work in, or have insight into, these neighbourhood health-based teams, as well as those working at a system level. We will share further insights as the work develops. If you would like to know more about this work, please get in touch.