CEO blog - Thoughts on Neighbourhood Teams (Part 3)
Thoughts on Neighbourhood Teams (Part 3)
Workload transfer is not transformation Moving activity is different from redesigning care. If activity shifts out of hospital and general practice absorbs unfunded co-ordination work, that is not transformation. If community services inherit more complexity without capacity, that’s not integration. If a digital tool creates more triage, monitoring and administration for already stretched teams, that’s not innovation. If patients still experience delay, duplication, repeated assessments, and unclear ownership, then the system has not transformed.
The pressure has simply changed location. That is workload transfer dressed up as transformation, and NHS teams can feel the difference very quickly. General practice feels it when another pathway lands without any prior engagement or resource. Community teams feel it when complexity increases without support. Hospitals feel it when they are expected to release activity but remain responsible for the consequences. Patients feel it when they still have to navigate the gaps in the services they need.
This is why neighbourhood healthcare must start with the pathway, not the structure as mentioned in my earlier blog.
The best neighbourhood conversations I have seen to date do not begin with organisational design. They begin with overlap. Where there are often two or more teams already dealing with the same patient group, the same pressures, or the same pathway problem. That is usually where the opportunity can be identified to start the conversation. It may be the overlap between:
general practice and district nursing
hospital outpatient follow-up and community management
diagnostics and referral management
mental health, voluntary sector support, and the primary care system
community pharmacy, long term condition management, and access
The point is that operational pressure often builds in the gaps between the services. Nobody owns the gap. Patients experience the NHS as movement, waiting, communication, repetition, escalation and whether someone clearly owns the next step. They do not experience the NHS as a structure chart so often beloved by management consultants and NHS strategic planners.
Three questions every neighbourhood team should answer
1- What is happening now?
Not what the pathway says should happen. Not what the service specification says. Not what leaders hope is happening. What is actually happening? Examples might include -
Who sees the patient?
Who assesses them?
Who follows them up?
Who orders the test?
Who checks the result?
Who explains the next step?
Who escalates when things deteriorate?
Who carries the administrative work?
Who fills the gaps when the pathway does not work?
This is often where the truth appears, because in many NHS pathways, the formal pathway and the patient lived pathway are not the same thing.
2- Where is pressure being created?
This is about making the friction visible.
Where is work duplicated?
Where are patients assessed more than once?
Where does communication break down?
Where does general practice absorb hidden coordination work?
Where do community teams inherit complexity?
Where does secondary care continue holding activity that could be managed differently?
Where are referrals made because escalation routes are unclear?
3- What needs to change?
Not what solution do we want to sell, not what structure do we want to announce. What needs to actually change operationally?
Agreed clearer referral criteria.
Agreed escalation routes.
Agreed shared protocols.
Named clinical and operational owners.
Different workforce assumptions.
Better communication routes with built-in feedback.
Different contracting model(s).
Clearer hand back processes.
Safer ways of managing risk.
That is how neighbourhood healthcare becomes practical – through better operational design.
We should recognise at the start that some neighbourhood models will fail
Some neighbourhood models will fail because they will confuse activity with impact. They will create groups, meetings and workstreams, but patients will still move through the system in the same fragmented way. Some will fail because they rely too heavily on goodwill; they move work without moving capacity; nobody has clarified ownership and escalation remains too vague; or they underestimate workforce reality.
You can feel the difference when neighbourhood working is real. Communication will become easier, escalation becomes clearer, duplication reduces, patients move differently and teams feel pressure easing rather than simply shifting. Going back to the first part of this Blog as I mentioned focusing on structures will not move you forward. You risk having lots of strategy, lots of governance and lots of agreement but very little change in the patient lived pathway.
William Greenwood
Chief Executive