Revealed: ICBs divided on ‘neighbourhood teams’

Neighbourhood health is expected to be a major focus in this summer’s 10-Year Health Plan, joining up teams in the community across health, social care, and the voluntary sector, and curbing demand on hospitals.

Integrated care boards have been asked to prioritise developing the teams.

However, information obtained by HSJ  reveals divergence between ICBs on early decisions.

A laissez-faire  national approach has resulted in some very large neighbourhood teams (NTs) that cover patches much bigger than previously recommended, and larger than locally recognised “neighbourhoods”. Similarly, they are divided on whether to build the teams around boundaries which match GP practice areas, such as primary care networks, or municipal boundaries.

The work, from freedom of information requests, found:

• Twenty-three ICBs have established named NTs covering their entire system; seven have done so only in some areas; and nine said they were still working on defining any NTs. Three did not provide information;
• Of 27 ICBs which provided population sizes for teams covering at least part of their area, 12 systems had at least one NT of more than 100,000 population (see size chart below);
• Overall, 57 of 509 NTs with defined populations (11 per cent) covered at least 100,000 people. Previously a 50,000 maximum had been recommended; and
• Of 30 ICBs which supplied information on NT areas, in 11 areas (37 per cent) they exactly or nearly matched existing PCNs; nine did not – instead matching some form of administrative boundary; while 10 had a mixture, following PCNs in some areas and other boundaries elsewhere (see map below).

The figures lift the lid on a debate raging nationally and locally about how to define and structure NTs.

In many patches, some services have been working in loosely defined neighbourhoods for many years. But the growing pressure from the centre to develop more comprehensive NTs  is forcing decisions and tensions about boundaries and size, sources said. In many areas they are still developing.

Some have picked PCN footprints as the natural building block. These are made up of GP practice catchment areas, and were largely decided by member GP practices in 2019. Generally they cover a 30,000 to 50,000 population – a range also suggested for neighbourhood teams in the 2022 Fuller Stocktake  review. 

However, some leaders argue NTs must match the administrative boundaries, such as wards, districts or boroughs, which are often used and recognised by other council, NHS, and other services.  

South East London ICB told HSJ  “it has not been possible to fully align” NTs with PCNs other than in one of its boroughs (Bromley), adding: “The focus is therefore on working through how PCNs can engage meaningfully and play a leadership role in more than one neighbourhood.”

Meanwhile, Bedfordshire, Luton and Milton Keynes ICB told HSJ  local authorities led work, with partners, to determine its neighbourhood footprints, which typically cover several council wards. These are designed to be at an efficient scale to bring together health, care, and voluntary, community and social enterprise organisations, the ICB said. 

Likewise, Norfolk and Waveney told HSJ many of its teams “operate around the former clinical commissioning group footprints”, with “certain roles within teams” linking with PCNs and GPs “based on needs”. 

Derby and Derbyshire ICB told HSJ  that systems were “expected to make sensible decisions to adapt to local communities”, meaning that while its NTs in Derbyshire generally match one to three PCNs each, in Derby city they do not, as PCNs “don’t follow either geography or similar populations” to other boundaries.

It had “logically utilised… existing partnership relationships and networks to develop our version of [NTs]”, it said.

Likewise, North West London has recognised not “fully aligning” boundaries to PCNs was a “challenge” in its plan for NTs, which are organised within borough councils.

Wide range in size 

While many neighbourhoods serve 30,000-50,000 populations, other ICBs told HSJ they were working on much larger areas. The big range is shown in the chart below. 

Bath and North East Somerset, Swindon and Wiltshire said its neighbourhoods matched its “place” teams – making them the largest nationally, at 200,000-500,000.

There is significant variation in approach within some systems.

In Hertfordshire and West Essex, for example, NTs are aligned to PCNs in West Essex, with one PCN per neighbourhood, with populations averaging around 56,000. But in Hertfordshire, the teams are organised by locality areas, with populations just over 100,000.

Integrated neighbourhood team (INT) population sizes in North East London, meanwhile, vary from around 30,000-100,000. The ICB said this “is very much in line with national benchmarks”, but it is building “a process of sense checking that the emerging neighbourhoods are of a size to fulfil their objectives”.

Cornwall and the Isles of Scilly, meanwhile, is home to the smallest NT, covering the 2,446 people on the Isles of Scilly. The neighbourhood matches the smallest portion of a PCN, which itself spans the Isles of Scilly and South Kerrier.

NHS Confederation primary care director Ruth Rankine told HSJ  the variation in the population sizes and footprints was welcome, as it indicates a flexible localised approach.

Warning against fitting NTs to existing NHS structures such as PCNs, she said these “may be completely different to what local communities think of their neighbourhood”. What matters for NTs was providing “proactive, personalised care that improves health and wellbeing”, she said.

National Association of Primary Care joint CEO Matthew Walker agreed: “The important thing is that the configuration makes sense to the community to which it applies.”

He added: “Part of this planning will involve building the right teams around the needs of their communities. This approach can bring a challenge to traditional thinking based on economies of scale or existing geographical boundaries.”

Leaders working on developing neighbourhoods said they were concerned about the 50 per cent cut to ICB staffing ordered this year, as they are reliant on the boards for infrastructure. One INT leader said: “Data to support population health is the area we need the most help with.”

HSJ also approached the nine ICBs which were not able to give names or areas for any teams. Of those which responded, all said they were working to develop their approach this year.