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It can’t be based on the area of a GP …" /> <meta name="DC.Contributor" content="Helen Salisbury" /> <meta name="article:published_time" content="2024-11-19" /> <meta name="article:section" content="Opinion" /> <meta name="citation_title" content="Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff" /> <meta name="citation_journal_title" content="BMJ" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2024/11/19" /> <meta name="citation_mjid" content="bmj;387/nov19_10/q2556" /> <meta name="citation_id" content="387/nov19_10/q2556" /> <meta name="citation_public_url" content="https://www.bmj.com/content/387/bmj.q2556" /> <meta name="citation_abstract_html_url" content="https://www.bmj.com/content/387/bmj.q2556.abstract" /> <meta name="citation_full_html_url" content="https://www.bmj.com/content/387/bmj.q2556.full" /> <meta name="citation_pdf_url" content="https://www.bmj.com/content/bmj/387/bmj.q2556.full.pdf" /> <meta name="citation_issn" content="1756-1833" /> <meta name="citation_journal_abbrev" content="BMJ" /> <meta name="citation_doi" content="10.1136/bmj.q2556" /> <meta name="citation_pmid" content="39562025" /> <meta name="citation_volume" content="387" /> <meta name="citation_article_type" content="Editorial" /> <meta name="citation_section" content="Opinion" /> <meta name="citation_author" content="Helen Salisbury" /> <meta name="citation_author_institution" content="Oxford" /> <meta name="citation_reference" content="Edwards N, Lewis R. Integrated neighbourhood teams: lessons from a decade of integration. Nuffield Trust. 15 Feb 2024. https://www.nuffieldtrust.org.uk/news-item/integrated-neighbourhood-teams-lessons-from-a-decade-of-integration" /> <meta name="citation_reference" content="citation_journal_title=Int J Integr Care;citation_author=RQ. Lewis;citation_author=K. Checkland;citation_author=MA. Durand;citation_title=Integrated care in England—what can we learn from a decade of national pilot programmes?;citation_pages=5;citation_volume=21;citation_year=2021;citation_pmid=34754281;citation_doi=10.5334/ijic.5631" /> <meta name="citation_reference" content="Royal College of Nursing. Nursing numbers plummet and waiting lists soar while government delays workforce plan, says RCN. 5 Jun 2023. https://www.rcn.org.uk/news-and-events/Press-Releases/nursing-numbers-plummet-and-waiting-lists-soar-while-government-delays-workforce-plan" /> <meta name="citation_fulltext_world_readable" content="" /> <meta name="twitter:title" content="Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:description" content="The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.1 In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? It can’t be based on the area of a GP …" /> <meta name="og-title" property="og:title" content="Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/387/bmj.q2556" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.1 In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? 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& Views</a></li> <li>Helen Salisbury:...</li> <li class="active last">Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff</li> </ol> <a id="main-content"></a> <div class="region region-content"> <section id="block-system-main" class="block block-system clearfix"> <div class="panel-display" > <div class="hero"> <div class="hero-wrapper"> <div class="hero-content" style="position: relative; left: 0px; top: 35.5px;"> </div>  </div>  </div>  <div class="row"> <div class="left-content col-xs-12 col-sm-8 col-md-8 col-lg-8"> <article> <div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1103465" data-node-nid="1103465" id="node-1103465--21919017395" data-pisa="bmj;387/nov19_10/q2556" data-pisa-master="bmj;bmj.q2556" data-apath="/bmj/387/bmj.q2556.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Opinion</span> <span class='bmj-series-title'>Primary Colour</span> <h1 class="highwire-cite-title" id="page-title">Helen Salisbury: Neighbourhood teams are disintegrating—to make them work, we need more staff</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2024</span>; <span class='highwire-cite-volume-issue'>387</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.q2556">https://doi.org/10.1136/bmj.q2556</a></span> <span class='highwire-cite-date'>(Published 19 November 2024)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2024;387:q2556 </span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <ul class="tabs inline panels-ajax-tab"><li class="first"><a title="Article Tab - Article" href="/content/387/bmj.q2556" 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data-panels-ajax-tab-preloaded="jnl_bmj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_bmj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="last" id="contrib-1"><span class="name">Helen Salisbury</span><span class="contrib-role">, GP</span></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>Oxford</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="em-link"><span class="em-addr">helen.salisbury{at}phc.ox.ac.uk</span></span><br/>Follow Helen on X <a href="https://twitter.com/HelenRSalisbury">@HelenRSalisbury</a></li></ol></div><p id="p-1">The aim of an integrated neighbourhood team (INT) is to bring medical, nursing, and social care services to the patient’s home (or nearby) in a timely fashion, which should prevent unnecessary hospital admissions and enable earlier discharge, thus saving the NHS money and minimising disruption for patients. These ideas seem so obvious that it’s hard to work out why they haven’t been tried before. They have, of course—but because such programmes identify unmet health needs, they usually result in more spending rather than less.<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></p><p id="p-2">In trying to understand the latest neighbourhood team iteration, one stumbling block is the definitions: what do we mean by a neighbourhood? It can’t be based on the area of a GP surgery, as they vary so much in size. Perhaps the unit could be the primary care network—but the hurried and bizarre way they were constructed means that the areas they serve can be many miles apart. Integrated care boards refer to “place based” partnerships, which rely more on local authority boundaries than health related ones. For me, neighbourhood means within walking distance, although this is hard to apply in rural areas.</p><p id="p-3">Some pilots of INTs have been well received, although it’s probably too early to say if they saved the NHS any money. Importantly, they had new, dedicated staff, and this changes the question from whether we can do this better with different organisation to whether more staff and resources help. The answer, not surprisingly, is probably yes.<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></p><p id="p-4">In our surgery we’re lucky: the district nurses and the health visitors have their offices in the same building. Alongside our monthly multidisciplinary team meetings, we have more useful chats when the nurses pop into our rooms to discuss some pressing problem for a particular patient: does this person need more antibiotics for their cellulitis? Is it time to get the community heart failure nurses involved? Is a safeguarding referral needed for this struggling family? It helps hugely that I know the patients and the nurses, and occasionally the answer is that I need to go and see the patient myself.</p><p id="p-5">Alas, our neighbourhood team is disintegrating. Because of a shortage of funds, the community trust responsible for our city’s health visitors and district nurses is about to concentrate all of them into a building three miles away, and I’ll lose the chance to discuss patients informally. Worse still, families who previously trundled their buggies five minutes up the hill from the council flats will need a 15 minute bus ride, with a walk at each end, to see health visitors. I worry that our least well resourced patients will be the ones most likely to miss out on care.</p><p id="p-6">We need more district nurses (numbers have fallen by 46% since 2009),<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a> and I’d find it helpful to have ongoing contact with a social worker who could explain what is and isn’t possible. INTs would be most effective if they had, at their core, GPs who knew the patients. To make that happen we clearly need more GPs, which means more funding for GP posts so that we have time for liaison and visiting. And we must maximise continuity so that each patient has a GP who knows them. Lengthy team meetings should be avoided, but building professional relationships across health and social care, so that you know who to call to prevent that Friday evening hospital admission, could bring rewards for us all.</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-7">Competing interests: See <a href="http://www.bmj.com/about-bmj/freelance-contributors">www.bmj.com/about-bmj/freelance-contributors</a></p></li><li class="fn-other" id="fn-2"><p id="p-8">Provenance and peer review: Commissioned; not externally peer reviewed.</p></li></ul></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-web" id="cit-387.nov19_10.q2556.1"><div class="cit-metadata unstructured">Edwards N, Lewis R. Integrated neighbourhood teams: lessons from a decade of integration. Nuffield Trust. 15 Feb 2024. <a href="https://www.nuffieldtrust.org.uk/news-item/integrated-neighbourhood-teams-lessons-from-a-decade-of-integration">https://www.nuffieldtrust.org.uk/news-item/integrated-neighbourhood-teams-lessons-from-a-decade-of-integration</a></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-387.nov19_10.q2556.2" data-doi="10.5334/ijic.5631"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Lewis</span> <span class="cit-name-given-names">RQ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Checkland</span> <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Durand</span> <span class="cit-name-given-names">MA</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Integrated care in England—what can we learn from a decade of national pilot programmes?</span><abbr class="cit-jnl-abbrev">Int J Integr Care</abbr><span class="cit-pub-date">2021</span>;<span class="cit-vol">21</span>:<span class="cit-fpage">5</span>.<span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.5334/ijic.5631</span><span class="cit-pub-id-sep cit-pub-id-doi-sep">.</span> <a href="https://ijic.org/articles/10.5334/ijic.5631">https://ijic.org/articles/10.5334/ijic.5631</a>. <span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>34754281</span></cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DInt%2BJ%2BIntegr%2BCare%26rft.volume%253D21%26rft.spage%253D5%26rft_id%253Dinfo%253Adoi%252F10.5334%252Fijic.5631%26rft_id%253Dinfo%253Apmid%252F34754281%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.5334/ijic.5631&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=34754281&link_type=MED&atom=%2Fbmj%2F387%2Fbmj.q2556.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-web" id="cit-387.nov19_10.q2556.3"><div class="cit-metadata unstructured">Royal College of Nursing. Nursing numbers plummet and waiting lists soar while government delays workforce plan, says RCN. 5 Jun 2023. <a href="https://www.rcn.org.uk/news-and-events/Press-Releases/nursing-numbers-plummet-and-waiting-lists-soar-while-government-delays-workforce-plan">https://www.rcn.org.uk/news-and-events/Press-Releases/nursing-numbers-plummet-and-waiting-lists-soar-while-government-delays-workforce-plan</a></div><div class="cit-extra"></div></div></li></ol></div><span class="highwire-journal-article-marker-end"></span></div><span id="related-urls"></span></div></div> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-trendmd" > <div class="pane-content"> <div id="trendmd-suggestions"></div> </div> </div> </article> </div> <div class="right-nav col-xs-12 col-sm-4 col-md-4 col-lg-4"> <aside> <div class="panel-pane pane-service-links" > <div class="pane-content"> <div class="service-links"><ul><li 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