A recent report from the National Association of Primary Care (NAPC) has offered a new solution to the GP access and funding crisis. It says that the key to reducing demand for GP appointments and solving primary care’s chronic underfunding lies in ‘segmenting’ the population into groups with similar needs – creating Integrated Neighbourhood Teams (INTs).

These neighbourhood teams would then work with existing Integrated Care Boards (ICBs) to create new ways of allocating resources – replacing the Carr-Hill system with more appropriate local solutions. 
This is one of the idea that is likely to feature in the much-anticipated 10 year NHS Plan that the government have promised to launch in the coming months.

INTs would share a common purpose, but at heart they would interact with the local population, helping to shift resources away from expensive treatment and secondary care, and more towards prevention in the community, and stamping out inequalities.

How these INTs will interact with PCNs is unclear and the report itself admits there is likely to be some “messiness”, and that compromises will be necessary.

Connecting the Disconnected

One of the most problematic assumptions to date is that all the various health and care teams in a neighbourhood know of each other, and what they all do. This is often not the case; under the sort of pressure they are often under, their work is disconnected and siloed. The problem is especially acute in domiciliary care.

Ultimately, secondary care partner like specialists need to be seen as crucial partners too in creating better ways of managing and understanding populations and their health needs. New infrastructure will need to be developed to facilitate this, and to reduce much of the time-consuming admin that stifles progress at the moment.

What Could Be Saved?

It is thought that most of the savings are not ones which would directly release cash that was otherwise not available – however the really valuable savings are expected to be those which boost capacity and allow for real health improvement, such as:

• Improvements in staff absence (14%), productivity (3%) and turnover (10%) from changes in staff engagement
• A 7% reduction in the cost of care for high intensity patients
• Reduction in GP demand (6%), outpatients (6%), ED attendances (12%) and bed days (14%)

The report offers a salutary warning for the future: “The lesson is that the NHS habit of offering unfeasibly large and rapid cash savings to appease the Treasury should be avoided.”

It was announced in early March that Cornwall ICB will invest £18m into integrated GP neighbourhood teams - four ‘early adopter sites’ and then others scaled up quickly. These will importantly include ‘integration of secondary care clinicians’ into each team, in an effort to try and avoid so many people being admitted to hospital in the first place.

You can read the full NAPC report here.