Workforce development within INTs across the London region, London’s five ICSs, 32 boroughs and the City of London will:

Bring together the full range of health, care and other professionals and volunteers to support local communities, at all stages of life and level of need.

INTs must be able to meet the needs of individuals and communities as they change and evolve. Whilst there will be a core team of professionals based around existing primary, community, mental health and social services in each neighbourhood, that team will also need to incorporate specialists and wider partners to deliver the required improvements in population health and address inequalities amongst the local population.

We will celebrate the neighbourhood workforce as an exciting place to work. This includes new, collaborative ways of working across clinical, professional and sectoral boundaries; new roles, such as Community Health and Wellbeing Workers, where these do not exist already; cross-skilling and upskilling of our current workforce, including but not limited to existing domiciliary and residential care workers; and greater empowerment of those working in the community to respond to individual needs, removing layers of bureaucracy and decision-making to be able to work in the most timely and efficient way possible. This will be supported by accelerated development of data and digital infrastructure, for patients, carers and professionals, as described in the related modules of this model.

Workforce development will be coordinated at system and place level including planning, training and professional development, together with required investment in organisational development across current organisational boundaries. This will encompass the need to bring together data around the current total workforce in each neighbourhood and place, and prioritise gaps to be addressed based on population health needs.

Integrated workforce planning will focus on shifting and expanding the workforce “upstream” into proactive care through recruitment, skills development reflecting the role of primary care and general practice; the need to make full use of the depth and breadth of health and care professionals working within neighbourhoods today; and the role of experts-by-experience.

We recognise that, in the development period of the neighbourhood health service in London, moving and bringing together individuals and teams will often be quicker and more effective than changing structures or funding flows. We will build on existing successful models across London of community-based joint working, including between specialists and generalists around both our older populations and in our children and family hubs, and commit to aligning our current resources around these, based where the targeted populations and the needs are.

Initiatives to support this will include maximising the use of Additional Roles Reimbursement Scheme (ARRS) funding within primary care; GPs with Extended Roles (GPwER); and new, co-developed community-based roles. Taken together with our existing workforce, these will help grow the breadth and depth of skills and expertise in specialist areas such as frailty; inject additional skills into the INT model, including more generalist capabilities; and attract new people into the statutory workforce and voluntary partners in each of our neighbourhoods, as part of our role as “anchor institutions”.

Investment in staff at all levels to enable the success of our INTs.

We recognise that integrated working is fundamentally about people, including developing new ways of working and new capabilities from leadership to the frontline. Staff need to be supported, trained, and motivated to meet the inevitable challenges and deliver transformation. Without this investment, the neighbourhood health service in London will fail.

INTs will be at the heart of this change, but will need organisational support at place level with capabilities in HR and organisational development to enable them. This is about creating, across hundreds of neighbourhoods, the capacity to shift from current siloed models of delivery into neighbourhood-based, integrated teams being business as usual. Each place partnership in London, working with its constituent organisational partners, including those operating at a larger scale, will need to encompass:

• Establishing, socialising, and aligning the total workforce of that place to a common vision, purpose and priorities for each neighbourhood. As part of this, individual performance and contractual levers will need to be considered in the context of the outcomes that the neighbourhood health service is being asked to deliver.
• Establishing a common language for neighbourhood-based working and integration that can be consistently applied and understood across all levels and organisations, even whilst we prioritise specific areas/cohorts to commence this change.
• Developing skills for integration and a team of teams approach to working, building shared understanding of each other’s roles and services and transcending more traditional, organisation and sector-based approaches to leadership and management.
• Supporting staff to work safely around the boundaries of their current roles and responsibilities, where this is needed to deliver the best outcome for the person they are providing care to.
• Leadership and stewardship capabilities for integration and cross-organisational working, including care planning, co-ordination and delivery at an individual, community and neighbourhood, place and system level – recognising that a disconnect between any of these will undermine confidence and performance for all.

We will invest in leadership development, including community leadership. The skills and capabilities of leaders to deliver organisational change will be a determining factor in the success of INTs. Leadership development is required to ensure leaders and managers are equipped to:

• Model culture change, integration and cross-organisational working;
• Step outside of their organisational boundaries;
• Promote partnership working at all levels, prioritising related relationships;
• Uphold joint accountability for risk, safety and overall outcomes;
• Embed new roles and structures;
• Maintain alignment across organisations and with the wider system;
• Address barriers and identify opportunities;

The workforce “enablers” of an integrated neighbourhood team are consistently available across each place.

This means there is an established team of teams identifiable within and across INTs. INTs can only succeed if their constituent parts are aligned around and bought into the same common outcomes and aims, or they risk reproducing siloed working practices. Staff must feel engaged, identify with one another, and trust and understand each other – this process of team-building will take time and investment.

Integrated, data-led workforce planning will bring together workforce data from each place to enable development of the neighbourhood workforce in-the-round, to fairly distribute available resource, and to plan jointly for the long-term. Workforce planning in this context will include system-wide recruitment and capacity optimisation planning across all partners including primary care.

Integrated training delivery will ensure consistent upskilling across organisations, and provide opportunities for staff to come together, collaborate, and share learning. Integrated training needs to include not just heath staff but social care and the voluntary and community sector, to enhance shared learning and ensure seamless care in every contact. Practically, this will include:

• Joint induction and, where appropriate, joint training including in cross-skilling and up-skilling those who are in the most frequent contact with people living in our communities and neighbourhoods.
• Cross-organisational work shadowing and rotations to increase understanding of different roles and organisations with INTs.
• Communities of Practice focussed on sharing and spreading “what works”, including in relation to clinical effectiveness and wider psycho-social interventions to address inequalities and improve wellbeing.

Retention strategies for all INT partners co-developed with staff, with detailed structures for career progression, training, supervision, and staff wellbeing initiatives within an INT context. Where possible and appropriate, role flexibility should be prioritised to reflect the needs of the workforce and to enable proper work/life balance.

We will co-create updated role descriptions with people to reflect any shifts to enable more effective joint working with patients, service users, and within communities; as well as in supporting operations, administration, and commissioning. Staff will be empowered to develop a broader range of generalist skills, (alongside more ‘traditional’ clinical and professional skillsets), such as:

• An ability to work across organisational boundaries and navigate systems and work amongst different organisations to deliver continuity of care;
• An ability to make decisions based on population health management data and insights;
• Integrated quality improvement building on iterative quality improvement approaches based on improving performance and outcomes across organisational boundaries;
• Psycho-social skills for the delivery of holistic
  care and support;
• INT-related skills and capabilities embedded
  within regular supervision and informal support.

Workforce metrics will be put at the heart of Place based reporting and assurance, where this is not happening already. We recognise that workforce planning is only as good as the data it is based on. Workforce metrics must be consistently applied across all partners, and should include, as a minimum: turnover, staff satisfaction, vacancy rates, improvement and staff absence, productivity, staff engagement, skill sufficiency measures, and surveyed views from staff to show alignment to goals and understanding – across health, social care, and wider partners. This will be a key part of establishing the health of our neighbourhoods and the INTs that support them.

We will reduce the burdens for VCFSE groups working as part of our INTs including through providing additional support and investment into recruitment, development and training for voluntary organisations, and providing shared and up-to-date resources, for example, around safeguarding and governance frameworks, enabling them to work more effectively with statutory partners.

Neighbourhood teams will act as a “bridge” between communities and key anchor institutions helping to promote volunteering and recruitment within local communities as new opportunities arise, to ensure that the benefits of a shift towards more proactive, preventative, community-based and technology enabled care are shared; and that our teams reflect the communities they serve.