Neighbourhood Health Teams: Delivering Care Where It Matters Most

The concept of neighbourhood care isn’t new. In fact, the Labour government’s push for neighbourhood care teams and more localised care delivery is the second or third real attempt by a UK government at achieving such a transition away from hospital dependency – albeit this is the biggest push to date.

So, why neighbourhood care? And why now?

In Dr Sood’s words: “We know that hospitals are taking up a lot of resources. We know that the vast majority of spend is in that segment of the ecosystem. We also know that the interactions many of our patients are having are at the primary community care level. There’s imbalance of funding flow, imbalance of where the majority of services are being used, but also where a lot of our workforce’s tasks are.”

The reality is that we’re starting to see diminishing returns based on investment; that the acute side of healthcare has hit a saturation point where it’s no longer optimal to invest more to achieve more. 
This is one of many considerations taken into account by the Darzi Report: that the current NHS system and associated care services aren’t designed in a way to deliver more localised care, even if there’s appetite for it. Fixing this will be an incremental shift due to the sheer size of the UK’s health and social care system and the population base that uses it, and the costs associated with change in any walk of life. 

Below we’ll touch on four key aspects of neighbourhood care delivery – Integration, Prevention, Technology and Reform – before finishing with some strategic advice to round off.

For more comprehensive insights, watch our webinar recording.

Dr Sood’s first big point in our conversation was the need for far greater coordination across teams and organisations.

“How do we enable a care coordination type platform? Or have something that I log in, or other team members can log in to, and see all the different touch points of who you know ‘Doris’ has been involved with in terms of her care over the last six weeks?”

This also raises a concern about the ability to communicate between different health and social care professionals, so that information, data and instructions can pass freely and quickly to ensure optimal care delivery and accurate treatment or support.

One potential solution – in Harpreet’s mind – is the NHS app, which would hold all key information and serve as a centralised point around which other solutions could orbit and contribute to, and act as a single source of truth that neighbourhood care teams could operate from. 

The hope and ambition is that neighbourhood care services can prevent healthcare deterioration at a localised level; one that’s convenient for the user and enables them – and the clinicians they see – to develop familiarity and trust that will encourage earlier engagement and a better chance at reducing the severity of injuries or illnesses, as well as supporting those with longer term conditions and keeping them away from crowded hospitals.

In response to a question from Laura about prevention needing upfront investment, Dr Sood’s stated that prevention must be prioritised through new funding models, outcome measures, and digital tools that support proactive, personalised care rather than reactive treatment.

There are issues around waiting lists, the number of scans, the number of diagnostic interventions… metrics that are dictating care delivery rather than a person-centred approach that puts people’s needs first. That’s not to say that appropriate usage of funding isn’t one of the most important aspects of healthcare service management, but adjustments need to be made if patient engagement and patient satisfaction are to both improve.

The accountability of staff is also something raised by Harpreet in his comments, and a challenge about the desire for prevention but a lack of understanding: “I think it's a really good sound bite… but actually very few people know how to do it or know what a good model looks like.”

The harsh reality is that time is limited, money is finite, and whilst patients might want 30-50 minutes to chat with an expert medical professional, appointments are very rarely more than 10 minutes long. It’s hard to provide a holistic assessment or to be proactive in diagnostics with brief contact.

When asked about the digital tools that Dr Sood as a GP is using (or is seeing colleagues use) to help with preventative care, he flagged the past push for electronic patient records as a key foundational block that has allowed more technology to be implemented.

He also cited wearable technologies and home care devices that can support independent living as big aids in early diagnosis and alerting either the individual or clinicians that a problem has arisen. For Harpreet, AI is invariably the big talking point at present, but whilst the pragmatic view is that it’s not a panacea, there’s still huge benefits to be had from artificial intelligence and machine learning in terms of analysing large data sets and presenting ever-more detailed findings; analysis that could help spot problems before they become an issue for a patient and minimise the expense to the NHS.

To make the time necessary for preventative care, you need smart solution to optimise workflows. Technology should enable frontline teams, not burden them, and it should have a focus on coordination, communication, and local innovation to deliver care where it matters most.

For neighbourhood care models, Dr Sood believes that solutions developers need to open up their APIs and be more open to integration and interoperability. “Real technology being used because it's been designed by people in the local community for local people”.

For any of the above to happen, there needs to be reform. Change can be scary, especially when patient lives are at risk, but for neighbourhood care teams to work, there needs to be bravery from the NHS in the shift towards integrated, community-based care. It cannot be a rebrand.

The government’s Fit for the Future strategy has three main shifts identified: neighbourhood care (from hospital to community) is one, whilst there’s also a desire to move from analogue to digital and from sickness to prevention. While these goals are familiar, the system has yet to be structurally reformed to deliver them at scale. Progress will depend on aligning funding, workforce, and accountability with these ambitions.

In Dr Sood’s mind, reform is needed so that the right teams of health and care professionals can be brought together: multidisciplinary team members across the NHS, social care, and local government that have the local population’s best interest at heart and the competency to collaborate and deliver.

This then raises an issue over accountability. A gap in the current thinking is about how these MDTs will be held to preventative outcomes, and that success is still defined by throughput, not health span. There’s also the issue of leadership, and who will take point on the accountability but also set the example to colleagues and demand both professionalism and high standards?

This brings us to the all-important finale: how do we achieve this? How can we successfully implement neighbourhood care teams and finally move unnecessary services away from the hustle and bustle of hospitals?

Dr Sood offers three points: 

1) Map out local needs

Know what the local population wants and needs, and which of these needs are going unmet to help balance the allocation of resources in service provision. Start with resolving the issues but steadily work towards preventing the problem from ever being an issue for your neighbourhood.

2) Recruit rockstars

Not a literal statement, Dr Sood argues for the right people in the right roles to give neighbourhood care the best chance at showing its true capability and value. Whether this is a GP, a social worker, or a data analyst, one sub-par person in the chain can stall all workflow.

3) Deadlines

Teams need motivation, and deadlines are a great way to break deadlocks in opinion or working culture. Neighbourhood care won’t work overnight, but many such projects stall through indecision – whether right at the start, halfway through a timeline, or just before the end.

By getting things moving, localised services are being delivered, an impact is being had, and learning can be done concurrently. After all, it’s called best practice. You can’t understand a process without first performing it.

This is where the rockstars professionals come in, though. The public – and the executives – will always demand immediate evidence or results to show a project is worth its salt, but the truth is that these neighbourhood services are a long-term project. This is why they need the best working on them, so that they can show immediate workings but also have the composure and confidence to stand tall against possible critique and to build the foundations necessary so that localised care becomes both the norm AND the first port of call for the British public. The NHS needs this change, and thankfully there are experts like Dr Harpreet Sood offering their insights and support to make it happen.

We are incredibly grateful for the time and wisdom given to us by Dr Sood. For more detailed insights, please watch the full webinar video via the banner below.