Dr Minesh Patel
NAPC Senior Leadership Team
Integrated Neighbourhood Teams (INTs) are transforming primary care by bringing together health, social care, and community services to provide proactive, patient-centred care. But how does this work in practice from a GP’s perspective?
Dr. Minesh Patel, a GP actively involved in INTs, shares his experience of how these teams’ function and the real impact they have on patient care.
The greatest influences on people’s health and wellbeing come from outside direct healthcare provision. Without paying attention to this, we are in danger of re-creating the same complex layered and fragmented solutions to our populations’ increasing health challenges and the challenge for services to meet growing demand.
Breaking Down Silos and Focusing on Staff Activation
One of the key benefits of INTs is the removal of traditional barriers between services. By fostering collaboration between GPs, social prescribers, community nurses, mental health practitioners, and voluntary organisations, INTs ensure that patient needs are met holistically.
For example, instead of a GP managing a complex patient’s care in isolation and making multiple referrals, an INT allows for joint decision-making with other professionals. This means quicker access to the right support, reducing unnecessary hospital admissions and improving patient outcomes.
It takes time and support to build trusted working relationships and build ‘real teams’ based on common purpose, working closely with each other and evaluating work together.
Staff who have the knowledge, skills and confidence (i.e. are activated) to undertake their roles are more likely to provide high quality care, innovate and go the extra mile.
Thinking upstream – Enabling people to create their own better health, preventative and proactive care
Dr. Patel highlights that INTs enable a shift from reactive to proactive care. By using data and local knowledge, teams can identify at-risk patients and intervene earlier, through targeted community support. Importantly, an INT needs to be a good partner with all those voluntary and peer groups and other organisations, for example housing support, employment support, day centres, gyms, voluntary groups and charities that support people to overcome barriers and improve their health and wellbeing.
Enhancing the GP Role
Rather than adding to a GP’s workload, INTs can alleviate some of the pressure through better collaboration and less bureaucracy. By sharing responsibility with a broader team, GPs can utilise their skills and focus on complex people while other professionals address social and psychological factors affecting patients’ health. This leads to better job satisfaction and improved patient care.
Activating our population in a digital age
As our population ages and with more people developing chronic diseases, we can’t continue to largely ignore underlying risk factors such as unhealthy weight, smoking and social isolation. Nor can we afford to deliver care in the same way we are now. Making sure that our INTs use every opportunity to nudge behaviours, use social prescribing skills, digital support tools and make best use of local assets to address health risk factors is better for people, makes effective use of resources and likely to be more environmentally friendly. There are great examples of organisations using group consultations to good effect to activate and support groups of individuals with the same chronic conditions, with better outcomes and using less clinician time.
Final Thoughts
Dr. Patel’s experience reinforces that INTs are not just a concept but a practical and effective approach to delivering integrated care. By working collaboratively, GPs and other professionals can enhance patient outcomes, manage workload more effectively, and create a more sustainable primary care system. As more areas adopt INTs, the challenge remains: How can we ensure all professionals and communities embrace this way of working? The answer lies in being patient and there will be barriers and ups and downs, ongoing collaboration, clear communication, and a shared vision for person-centred care.
