Shifting to a neighbourhood model of care will require a fundamental transformation of relationships between statutory services and communities, according to a new NHS Confederation report.
The report, A case for neighbourhood health and care, states that though policymakers have long talked about a more ‘joined-up’, proactive care with flexibility to respond to local needs, that ‘this is not how our health and care systems operate or are experienced by communities today’.
Based on a review of literature on community and neighbourhood working, the report adds that the factors driving poor health and ‘the most successful responses’ sit outside the conventional reach of the NHS.
‘Not only are medical solutions to social problems unlikely to work, but there is an increasing risk of ‘moral injury’ to healthcare staff when they are asked to solve problems for which they can’t provide the answer,’ it states.
‘This is reflected in growing issues of both recruitment and retention of highly qualified and committed staff, across the health and care sectors.
‘No one agency, service or group holds the answer to these problems. What is needed is coordinated, system-wide action that spans communities, health, criminal justice, employment services, education and local government,’ it states.
One ICB chief executive involved in the report said that this was less thinking about working ‘in’ the NHS, and more about working ‘for’ the NHS and the communities served by it.
It highlights that solutions needed to be developed and delivered by and with the people who are most affected meaning a ‘higher level of engagement between statutory services and communities than has been the norm in many neighbourhoods and requires a much more local focus’.
It adds that the future of primary care was ‘intrinsically linked’ to the neighbourhood model and includes 14 case studies of neighbourhood working.
‘In some areas, the GP practice or local pharmacy may be the only community asset left,’ it states.
‘There is significant variation in the capacity of individual practices, social prescribers and the PCNs that support them to move beyond traditional patient engagement to partnership working with communities.’
The report adds ‘Enabling GPs and wider professionals to engage and work more proactively with their communities will require changes to how primary care services are contracted, funded and assured, to unlock capacity and optimise at-scale provision/expertise in primary care.’
The report also cautions against spending time on defining what a neighbourhood is as they can vary from a ‘few houses to a residential area of 50,000 people and above’. Instead it recommends that statutory services need to focus on ‘thinking neighbourhood’ in all they do, and taking the time to understand and engage with the local population, ‘to engage them in developing insight and data, and in leading on local change’.
Last month, Lord Ara Darzi’s report highlighted that there are tensions between ICBs and providers, and that these were ‘essential’ to resolve for the future of the NHS.
