Digital Neighbourhoods
The South West Digital Neighbourhoods Programme aims to transform the experience of the citizens we serve and the workforce we support by empowering integrated neighbourhood teams with the best use of digital technology and data, to provide proactive, preventative and personalised care at a local level.
Over 40 Primary Care Networks (PCNs) and individual GP practices in the South West are taking part in this regionally NHS-funded programme.
Since 2023, teams have been implementing and making plans for using an AI-based digital tool called Brave AI. This tool helps healthcare teams use data more effectively, so they can quickly identify people who may be at risk of becoming seriously unwell, or who could benefit from extra support.
Those people can then be contacted and invited to take part in a conversation about their health and wellbeing, so that local, integrated neighbourhood teams – made up of a range of health and care professionals – can work with patients to develop a personalised care and support plan.
All of this leads to integrated neighbourhood working, responding to the needs of people at a local level, asking ‘what matters to you?’ instead of ‘what is the matter with you?’.
Personalised plans may include support delivered in-person, online or in the community – such as local classes and groups – or using digital tools and technology to help people to stay well at home.
This neighbourhood health approach will underpin the NHS 10 Year Plan, supporting people in the South West to live healthy, active and independent lives for as long as possible and driving the ‘three big shifts’ in health and care: from hospital to community, from analogue to digital, and from sickness to prevention.
Arbennek PCN in Cornwall, a Digital Neighbourhood Vanguard, have been using Brave AI since July 2024.
Rob Attridge, Strategic Manager at Arbennek PCN said –
‘’Brave AI has been a huge catalyst for driving integration at a local level. Our integrated neighbourhood team includes everyone from our clinical director to practice managers, community nurses, public health professionals, social care, the voluntary sector, and more.
‘’Before collaboration might have been difficult. But using this tool, to help identify patients who may not otherwise have been flagged as at risk, gives us a common purpose and focus for interventions.
‘’The variety of professional experience in the team allows us to look at patients with more curiosity and support them in a holistic way. Often conversations will reveal new partners we can bring in, each with fresh ideas for what ‘success’ might look like for that person.
‘’We’re seeing real, improved outcomes for patients – not just in terms of their risk of being hospitalised going down, but also through softer measures such as the language they use around their health and care. Brave gives the integrated neighbourhood team a way to see and demonstrate the impact that these interventions are having, and our colleagues are thriving in this environment. Everyone feels very positive about working in a more targeted, innovative and meaningful way.’’
Wider support
The Digital Neighbourhoods Programme is also funding an additional 10,000 places for South West Digital HOPE. HOPE is a course which seeks to empower people with long-term physical and mental health conditions by providing them with the knowledge, skills and confidence to improve their health and wellbeing, incorporating digital tools to make life a little easier.
The Digital Neighbourhoods team are committed to continuous learning, often looking outside the programme for examples of digital technology and proactive, personalised care in action. Our Community of Practice is open to all. We regularly invite guests to share their views, learning and experiences at the sessions.
If you work in the NHS or wider health and care system in the South West and would like to find out more or get involved, please join the Digital Neighbourhoods FutureNHS workspace or email: england.swdigital@nhs.net to subscribe to newsletter.