Sackwell and Binthorpe bulletin: Towards neighbourhood teams

The latest bulletin from the Sackwell & Binthorpe ICS offers a steer on establishing a ‘team of teams’ in your neighbourhood

Greetings, emergent integrated neighbourhood team members. It’s Penny Stint again, with your regular update from the primary care support and strategic intelligence unit (PCSSIU).  

As you know, the Sackwell & Binthorpe integrated care board (ICB) is fully committed to rolling out integrated neighbourhood teams across the system before the end of this year.

These were the main recommendations to come out of Dr Claire Fuller’s report Next Steps for Integrating Primary Care earlier this year. The neighbourhood team is a ‘team of teams’ or network of PCNs responsible for:

• Developing a sense of shared purpose.
• Creating alignment. 
• Fostering collaboration.
• Driving integration.
• Improving outcomes. 

Dr Fuller’s report set out a clear vision and strategy. It is now up to individual neighbourhoods to fill in the operational details including:

• How it will work.
• How things are paid for. 
• Who’s in charge.
• Where the money will come from. 
• How we recruit the workforce.

Right now, we have exhausted staff and practices that are overwhelmed with work. That’s because they’re spending too much time seeing patients when they could be in meetings designing a better way to work. 

With any big change programme you need to have the courage to say we need to do something differently. 

It’s the job of PCNs working with integrated care systems (ICS) leaders to imagine what ‘different’ might look like. 

The role of the ICS is to support you to help you to make time for change. 

We are developing a suite of practical resources, including:

• Why You Have More Space and Time Than You Think (primary care quantum physics mythbuster). 
• The Shared Purpose Builder (step-by-step guide to proactive visioneering). 
• Setting Your Team Up for Success (top tips for managing large-scale change programmes, with a foreword by Lord Lansley, architect of the 2012 NHS reforms).

PCNs, neighbourhoods and places
There has been some confusion about the difference between these concepts. A PCN is a group of practices serving a population of between 30,000 and 50,000 at neighbourhood level. An integrated neighbourhood team encompasses more than one PCN, so is bigger than a neighbourhood but smaller than a place. A place encompasses PCNs and neighbourhoods as well as one or more secondary care trusts. Neighbourhoods could evolve to become places but only if other neighbourhoods move in to fill the resulting gap. 

I hope that clarifies the situation.

The S&B primary care heatmap
I’m sure you’ll be pleased to hear that primary care is to get its own heatmap, an alert system to show which practices are under pressure similar to the operational pressures escalation level (OPEL) system used to flag up problems with hospitals. 

A similar system trialled at S&B – the practice early warning system (PEWS) – will give the ICS and the national team advance warning about hotspots. 

Practices will report whether they are cool, tepid, warm, hot or nearing boiling point. Those close to vaporising (the highest level of alert) will trigger a range of support measures from the ICS. These may include additional resilience training, help to try harder, strong encouragement from the ICB or a personal visit from the director of performance and recovery at the regional team.     

We remain fully committed to preventing general practice from burning to a crisp.

PCNs make incredible progress
I always like to end this update on a positive note, so the last word goes to Dr Fuller. Asked if she felt PCNs were proving a success, Dr Fuller said: ‘It’s absolutely incredible what some areas have managed to achieve.’ Acknowledging that it’s too early to say what those achievements are, she said there were promising signs that NHS England would soon know.

It’s not surprising that PCNs sometimes worry about minor obstacles along the way, such as potential non-existence after 2024. But neighbourhood teams promise a more integrated future than ever for general practice. 

My team will continue to engage with you with meaningful offers of support as we embark on the next leg of the journey.

Penny Stint is primary care enablement lead for the Primary Care Support and Strategic Intelligence Unit (PCSSIU) at the Sackwell & Binthorpe ICS. As told to Julian Patterson