The five London ICBs and NHS England’s regional London team have published a plan for neighbourhood health across the city.
The document, A neighbourhood health service for London, outlined a targeted operating model, which said it will require clinical leadership, support and accountability at all levels of its 32 places, and the development of infrastructure within places to build neighbourhood operational capacity, both physically and digitally.
It also said there would be collaborative structures for shared learning and adaptation at a regional, system and place level.
Place partnerships will take the lead and overall accountability for planning, delivering and evaluating improved population health and reduced inequalities, it said.
But there will be one organisation nominated from within that place to host the functions required to enable partners to work together better at neighbourhood level.
The geography of the neighbourhoods will be defined by recognisable communities, neighbourhoods and population health needs, and will be determined by place partnerships and communities.
However, this may include a ‘re-alignment’ of PCN boundaries.
It said: ‘Where local statutory boundaries, including those of current PCNs, align with such natural communities, the boundaries may be co-terminus. Where boundaries do not align, re-alignment to these footprints or development of local arrangements capable of operating efficiently and effectively across them will be required.’
On population health management, the document said next steps were to implement a core, standardised London-wide approach to classifying the needs of local populations.
There will also be a 24/7 gateway to neighbourhood teams using digital and ‘other channels’, with a consistent approach to managing patient flow.
To enable this, the OneLondon shared care record will be developed to provide an accessible view of a patient’s health history.
The document set out priorities for place development, including agreeing who will host the integration functions and finalising the footprints of the neighbourhoods (see box for full list). It also set out priorities across London, including working with primary care to articular the support offer, and working to develop a strategic commissioning model for London across the five ICBs.
Suggested priorities for place/system development
Enabling integration
Agreeing who will host integration functions locally including supporting INTs and future local resilience, together with the relationship to the place partnership.
Geography
Finalising the footprints of London’s neighbourhoods based on local evidence and data, including existing capacity and demand, local assets, and needs.
Developing an identified set of priority cohorts (covering babies, children and young people; working-age adults; and older people), with interventions within each neighbourhood which apply a core offer for all Londoners and tailor and supplement this to reflect the individuals and communities who live, work and receive care there.
Participation
Developing localised, contextualised messaging describing “what the neighbourhood health service means for you” within each borough.
Ensuring effective community representation and leadership in decision-making around neighbourhood care.
Relationships and interfaces
Developing options around co-location where it makes sense, including exploring opportunities within existing and recognisable neighbourhood “hubs” as venues for shared delivery.
Ensuring key partners including domiciliary and residential care providers are part of the process of co-designing and INTs.
Population health management
Bringing together population health management insights and asset and resource analysis to identify gaps and overlaps in current neighbourhood provision, to inform shared planning and resource allocation.
Developing mechanisms to incorporate lived experience and qualitative feedback into planning processes involving communities, staff and other stakeholders to help ensure that interventions and approaches reflect and respond to lived realities.
Governance
Developing consistent neighbourhood governance structures which support and empower local clinicians, professionals, and communities whilst ensuring alignment with broader goals.
Access and technology
Clear signposting systems, agreed and facilitated by cross-sector partners, will help to reduce confusion and improve access to services.
Metrics
Mapping data associated with each population segment at a granular geographical level (eg within individual lower super output areas (LSOAs), to build a picture of need across a locality as well as “what good looks like” in terms of outcomes for local communities
Understanding geographic trends, variation, and drivers including measures of engagement/disengagement with health and care services.
The document was developed in partnership between London’s five ICBs, NHS England London Region, and the wider London Health and Care Partnership (London Councils, Greater London Authority, UK Health Security Agency, and the Office for Health Improvement and Disparities in London.
Dr Agatha Nortley-Meshe, NHS England London’s medical director for primary care, said the success of neighbourhood health would rely on ‘shared determination to build something better, borough by borough, neighbourhood by neighbourhood – moving care from hospitals, closer to communities’.
Chief executive officer for the London-wide Local Medical Committees, Dr Lisa Harrod-Rothwell, added that:’Every day, as GPs, we help patients navigate a fragmented and siloed service, advocating for them to get the best care wherever they need it.
‘We have colleagues working in other parts of this system who are as enthusiastic about working collaboratively as we are. We need to take this opportunity to bring everyone together.
‘The benefits could be seen across a number of areas, including patient satisfaction, clinical outcomes, financial efficiency, and health inequities. Morale, wellbeing, and job satisfaction can be massively improved if we are enabled to work effectively together, doing so with our patients and local communities.’
Chief executive officer for NHS South East London and co-senior responsible officer for this work, Andrew Bland, said:’Londoners deserve a system that works for them. One that is easier to access, more joined-up, and truly focused on what matters to them.’
‘This work is also about improving system sustainability across primary care, acute and community services, local government, and the voluntary and community sector. By working together and focusing on common goals, the neighbourhood health service will help provide more efficient and personalised care that is tailored to local communities.’
In February, NHS England’s chair Dr Penny Dash said bringing together integrated neighbourhood teams will take time.
It comes as the lack of a clear plan for the abolition of NHS England has been criticised by MPs.
Last week it was revealed that the ICB running cost envelope was to be reduced to £18.76 per head, after ICBs were told they must make 50% cuts. Bristol, North Somerset and South Gloucestershire ICB has already laid out plans to merge with Gloucestershire ICB as part of efforts to make cuts.
