Integrated Neighbourhood Teams – What are they?
An integrated neighbourhood team (INT) is a multi-disciplinary team approach across health and social care that aims to deliver coordinated holistic care, catered to the individual, within a specific community or neighbourhood.
Often containing professionals and stakeholders from various sectors including health, social care, mental health, community services, housing or education, these professionals work together to meet the diverse needs of the community.
Focusing on the needs and preferences of individuals, INTs ensure care is tailored to individual health and social care needs.
Through co-production, health and social care professionals as well as the individuals themselves can feel reassured that they will receive high-quality care and support through seamless integration of services across different sectors whilst avoiding duplication of efforts to ensure smoother transitions across health, social care, and community and voluntary services.
INTs are an example of front-door care navigation services, a commitment to improve people’s access to health and care services. Here early interventions and preventative care are emphasised to help individuals live more independently for longer, manage chronic conditions effectively, and avoid hospital admissions. This care is delivered within the community making it more accessible and relevant to the local population's needs.
What does an integrated neighbourhood team do?
Integrated neighbourhood teams aim to create seamless experiences for individuals receiving care and support by performing a variety of functions to provide comprehensive and coordinated care across the community, ensuring all aspects of health and social needs are addressed cohesively and effectively without long waiting times or going over budget.
INTs were introduced to address several challenges across health and social care systems to better manage the rising demand, avoid fragmented care deliveries, and prevent gaps in provision, duplication of services, and inefficiencies - all while enhancing user experiences by focusing on the individual’s whole needs not just their health.
By acknowledging the wider social determinants of health across the community, INTs offer better facilitated early intervention preventing further health and wellbeing decline, as well as enhancing job satisfaction and reducing burnout.
INTs were introduced as a strategic response to the rising challenges and issues across the health and social care market to improve care deliveries to break down barriers between different sectors. This was done to create a more effective and sustainable health and social care system, driven by a collaborative community approach focusing on what matters to the individual.
The table below demonstrates some of the ways INTs work and just some of the services they provide to deliver better joined-up front-door care navigation to ensure no population is left vulnerable or underserved.
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Holistic Assessments |
Conduct Comprehensive evaluations of an individual’s health, social, and psychological needs to create personalised care plans |
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Care Coordination |
Ensure seamless collaboration among healthcare providers, social workers, and other professionals to deliver integrated services. |
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Preventative Care and Early Intervention |
Identify and address health and social care issues early to prevent complications and reduce the need for acute and emergency care. |
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Chronic Disease Management |
Support individuals with chronic conditions through ongoing monitoring, treatment, and education to manage their health and wellbeing effectively. |
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Rehabilitation Services |
Provide rehabilitation and reablement services to help individuals increase and regain independence and functionality after illness or injury. |
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Mental Health Support |
Integrate mental health services to address emotional and psychological wellbeing offering counseling and support. |
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Social Care Support |
Assist with social determinants of health including housing, financial issues, and reducing social isolation. |
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Medication Management |
Ensure proper medication use and adherence, managing any side effects and interactions. |
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Health Education and Promotion |
Educate individuals on healthy living, disease prevention, and self-care practices. |
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Palliative Care |
Offer compassionate care and support for individuals and families dealing with terminal illnesses. |
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Crisis Intervention |
Provide immediate support during health or social crises, stabilising situations and arranging follow-up care. |
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Community engagement |
Work with local communities to understand their needs, build trust, and adapt services based on feedback. |
Integrated Neighbourhood Team – Why are they important?
INTs are important for several reasons. Ultimately, they enable communities to improve outcomes, create sustainable and high-quality health and social care deliveries, and most importantly they improve the quality of life for individuals across the community by increasing accessibility to all services available across a local authority.
1. Better holistic care
INTs are vital in providing comprehensive care that addresses both medical and social needs. This approach ensures that all aspects of a person’s wellbeing are considered to lead to better health outcomes.
2.Improved Outcomes
By coordinating care with various stakeholders, INTs can more effectively manage chronic conditions, prevent complications, and improve recovery rates. As a result, this leads to healthier populations and fewer acute health crises, helping reduce the strain and pressure continuously building on health and social care professionals.
3. Improved Efficiency
Using INTs helps provide a more seamless experience by streamlining processes and making the delivery of care more efficient, reducing costs associated with unnecessary treatments and hospital admissions.
4. Enable better preventative and early intervention services
As discussed above, INTs help to deliver better preventative care across all communities by identifying and addressing health and social care issues early before something more critical takes place. This is vital as it helps reduce emergencies and long-term health problems.
5. Prevent hospital admissions
By managing conditions more effectively across the community, INTs prevent many hospital admissions, especially for more vulnerable individuals or those living with more than one chronic condition.
6. Community Engagement
INTs are also important as they improve overall community engagement by involving local communities in both the planning and delivery of the care and support needed, to foster a sense of ownership and accountability within the community to lead to more effective care solutions.
7. Reduce care costs
By improving efficiency, reducing hospital admissions, and preventing health crises, integrated neighbourhood teams lead to significant cost savings for healthcare systems. This, in turn, enables these cost savings to be reinvested to improve services further and expand access to care.
Integrated neighbourhood teams are important therefore as they enable a better person-centred approach to care improving health outcomes as well as supporting the needs of more vulnerable populations, so no one goes without the support they need or deserve.
Challenges of Integrated Neighbourhood Teams
Despite the many benefits INTs can offer communities, they can face several challenges that can impede the success of the collaborative work between stakeholders, ultimately reducing the accessibility to support services for individuals across communities need.
The most significant challenge is ensuring effective collaboration and communication among diverse professionals and stakeholders across different sectors to build a stronger multi-disciplinary team using their expertise together to work towards the same goals and objectives.
Limited awareness of the benefits of INTs for all stakeholders involved can limit engagement and thereby the outcomes achieved. These teams must coordinate to overcome barriers, varying professional cultures, and differing priorities so individuals receive a fully holistic support system that can cater to all their needs.
Whilst setting up an INT can be challenging maintaining its delivery and success is also difficult. Seamless transitions and integrations between sector systems are needed to ensure a better continuity of care and information sharing to cater for the complex needs of a community.
Another key challenge when managing INTs is being able to demonstrate their effectiveness. Establishing clear metrics and evaluating the impact on health and social care outcomes, wellbeing, and cost-effectiveness is crucial, but can be challenging due to the multifaceted approach of the interventions and outcomes involved.
To address these challenges and ensure the implementation and continuation of INTs within communities is successful, commitment, collaboration, and adaptation to local contexts and needs from everyone involved is required to better manage needs, resources, and funding accordingly.
Integrated Neighbourhood Teams and Social Prescribing – What is the link?
Both integrated neighbourhood teams and social prescribing are linked approaches aiming to improve holistic care and wellbeing within communities, particularly across health and social care.
The goal of an INT is to provide coordinated and integrated care to individuals within a community by working with professionals including doctors, nurses, social workers, and sometimes housing officers and community workers, to better address both the medical and social needs of the community.
Similarly, social prescribing equally concentrates on improving the quality of life for the individual but concentrates solely on the non-clinical and social needs of the community to deliver care and support that matters to the individual. By addressing social determinants of health, such as loneliness, a lack of physical activity, and housing issues, social prescribing helps to refer individuals to non-medical activities within the community to improve their health and wellbeing.
Whilst both have similar aims it’s clear it is delivered slightly differently. What links the two approaches together is the need for a collaborative approach to personalise care plans and social prescriptions, the importance of community engagement for successful outcomes, and using resources effectively to improve health outcomes. Here both approaches are complementary strategies aiming to provide holistic care by addressing medical and social determinants of health within local communities.
How can technology improve integrated neighbourhood teams?
Investing in technology solutions massively enhances the effectiveness and efficiency of integrated neighbourhood teams by ultimately improving and streamlining workflows to improve care navigation and outcomes for everyone involved. Below are just some examples of how technology and specific digital solutions overcome the challenges of implementing, managing, and developing INTs:
1. Electronic Patient Records
Investing in Electronic Patient Record systems massively helps improve INTS by centralising patient records in one centralised place to better coordinate care and support as well as enable better coordination amongst team members.
Access Rio EPR, for example, is a future-proof EPR system for community, mental, and child health providers to help improve outcomes by providing holistic pictures of patients in your care. Through managing both administrative and clinical processes, our EPR software can be tailored to your INT’s and organisation’s specific needs. Developed in collaboration with many healthcare experts, we help to improve the quality of care, safety, and patient experience whilst increasing efficiency, even on a restricted budget.
2. More access to telehealth services
Telehealth services help improve INTs by offering more remote access to support for individuals. Better collaboration within the multi-disciplinary team meetings also can take place by allowing specialists to discuss patient cases remotely to better collaborate on treatment plans that matter to the patient.
3. Enhances communication and collaboration
Investing in technology also helps to streamline workflows and processes by ensuring accountability for every stakeholder within the team to enable more timely exchanges of information to deliver better-coordinated care.
4. Delivers better population health management
Equally investing in solutions to assist with your population health management approaches help INTs centralise all their information in one place to be more strategic at identifying at-risk populations. As a result, INTs can improve the accessibility of services for more vulnerable, remote, or underserved populations so no one goes without the care and support they require.
5. Online Training
Investing in digital solutions not only helps with the day-to-day running of INTs across the multiple sectors involved, but it also helps with online training to improve the overall working culture.
Here all stakeholders can learn and understand their role within the INT to be held accountable for their roles and responsibilities in improving community health and wellbeing. This, in turn, helps increase engagement and provide better front-door services to the community.
6. Improves collaboration with social prescribing services
One of the final ways investing in digital solutions improves INTs is through investing in social prescribing software.
At Access Elemental Social Prescribing we know and understand the importance of co-production to improve community health and wellbeing, that’s why our software is fully interoperable and flexible with leading clinical software, social care case management software (Access Mosaic) as well as other third-party solutions to improve communications and collaborations with stakeholders across the INT. As a result, all stakeholders have access to all the information they need in one centralised place to avoid duplication of data and allow more time to be spent with the individual co-producing their social prescription whilst ensuring it’s in line with their wider care plans.
Our social prescribing software also helps to improve access to community resources to ensure better resource allocation to ensure safe and assured referral pathways, so no individual is ever referred to an out-of-date service. This is done through our Marketplace module creating a fully up-to-date and optimised directory of services highlighting all the support groups and interventions available across a community to help with a variety of specific needs.
We go one step further at Access Elemental to enhance the collaboration within INTs by also integrating with our Access Rio EPR system. This, in turn, ensures whilst creating social prescriptions that matter to the individual, they are also aligned with patients' overall care plans by having access to their patient records.
Investing in technology and digital solutions is therefore critical to enhancing the collaboration of integration neighbourhood teams by streamlining referrals, improving communications between stakeholders, leveraging community resources, monitoring outcomes, and empowering stakeholders and individuals to achieve better health outcomes and wellbeing.
Summarising the importance of Integrated Neighbourhood Teams
This article has reviewed what integrated neighbourhood teams are and why they are important to support independent living, improve both physical and social wellbeing, as well as reduce demand and pressure on health and social care professionals.
Social prescribing is an approach that can be used within the INT to bridge the gap between stakeholders and offer one centralised platform where all information can be stored to better cater support to every individual need.
By addressing the challenges integrated neighbourhood teams can face when implementing the co-production approach and maintaining it, investing in digital technology helps to increase engagement and communication between stakeholders to improve outcomes.
Whether it’s health and social care professionals, housing officers, or charitable organisations, through investing in digital solutions better collaboration can take place advancing stakeholder’s expertise to ensure the right support and care is delivered at the right time to manage both medical and social needs.
At Access Elemental Social Prescribing we know the importance of collaboration and co-production to better tackle health inequalities across the community.
We also know the difficulties in collaborating with other stakeholders which is why our software is fully flexible and interoperable with multiple systems to make that process easier, manage referrals more effectively, and offer a centralised place to store, manage, and analyse data to make better data-led decisions in the future.
For more information on how our social prescribing software can improve co-production within your INT contact us today.
Let us show you first-hand how we can streamline your front-door services to improve care navigation as well as help you utilise available funding opportunities to improve your services further across your INT further.
