The next steps for the neighbourhood health service

The next steps for neighbourhood health have been revealed, with 43 places selected as neighbourhood pilots earlier this month.

The pilots, announced by the health secretary, were chosen from 141 applicants to be part of the neighbourhood health implementation programme (NNHIP).

This is a pilot that ICBs and local authorities were invited to apply to,  and  be part of the first wave of neighbourhood health, including an ‘intensive national coaching programme’.

Those accepted into ‘wave one’ of the programme were selected for their ability to provide ‘immediate’ improvements to patients in the most deprived areas of the country, with a focus on those with long-term conditions and patients affected by wider social and economic factors.

Cornwall and the Isles of Scilly ICB, whose application included Kernow Health CIC, the local councils, trusts, Age UK and some voluntary organisations, said the pilot would initially focus on patients with diabetes, arthritis, angina, high blood pressure, MS or epilepsy, in the areas with the highest deprivation.

It added that general practice would be the ‘cornerstone’ of this programme, but that it would also include community nurses, hospital doctors, social care workers, pharmacists, dentists, optometrists, paramedics, social prescribers, local government organisations and the voluntary sector.

Kate Shields, chief executive of NHS Cornwall and Isles of Scilly ICB, who has also recently announced she will step down from the role as the ICB begins to integrate with Devon ICB in a new cluster, said: ‘By being part of this national initiative, we can go further and faster in shifting care closer to home, preventing illness, and making the best use of digital innovation for our people.’

Healthcare Leader understands that in Doncaster, the LMC and GP Federation are taking the lead on the pilot and will create an accountable care organisation to deliver this.

While in one of the London pilot sites, Lambeth and Southwark, the South East London ICB  is to oversee the project.

However ICB chief executive, Andrew Bland, , added that they ‘will make sure the benefits are felt not just in our pilot site, but across all the boroughs and communities we serve’.

The pilot was also described as a ‘major step forward’ for local healthcare in Hillingdon, by The Confederation Hillingdon CIC, which represents general practice in Hillingdon, North West London.

In a recent LinkedIn post, the CIC said: ‘We are keen to get involved in solving some of the really knotty problems that will help deliver the vision; releasing estate for care closer to home, enabling the digital agenda, creating incentives and funding flows that support the changes needed, and the right environment for our workforce to thrive and deliver their best for patients.’

Supporting existing collaboration

However, in many of the places selected, work on neighbourhoods and integration is already established, with the pilot set to support existing collaboration.

Dr Shanika Sharma, clinical director at West One PCN in Barking and Dagenham, said she was ‘excited and happy’ that Barking and Dagenham was to be one of the 43 pilot sites, and that it would build on existing relationships.

‘We have a very collaborative working relationship in Barking and Dagenham, with all the six PCNs working in synergy to deliver services,’ she said.

‘For example, all PCNs subcontract to our GP Federation – Together First CiC – for enhanced access, and to our local authority – London Borough of Barking and Dagenham – for social prescribing. We have built a strong infrastructure in primary care over the last three years focused on tackling and reducing health inequalities in Barking and Dagenham.’

She added that they were also piloting new technology, including a skin analytics tool to diagnose skin lesions in the community which will provide ‘residents with faster access to diagnostics and supporting our local trust with referral volume’.

‘The vision is to build and expand on these with neighbourhoods,’ she said.

Another of the pilot sites, Kensington, Chelsea and Westminster, already has an established integrated neighbourhood team called Octopus, which connects the health sector with the local authority and voluntary organisations.

Dr Saul Kauffman, clinical director at St John’s Wood and Maida Vale PCN, in Westminster, said: ‘We’re really excited to be one of the 43 neighbourhood sites and look forward to continuing working together across our place in this exciting phase where we can learn and share ideas with other places round the country.’

Rita Thakaria, managing director of the Kensington, Chelsea & Westminster Place Based Partnership, added that being chosen for the pilot ‘reflects the strength of our shared vision, the trust built through collaboration, and the value we create together’.

In Sefton, where South Sefton PCN has won PCN of the year in 2024 for its collaborative work, the pilot will include community nurses and social workers working with GPs to identify those who need care early, as well as better access to healthcare for children and young people with teams ‘wrapped around schools’.

The neighbourhood pilot will also help to support those with complex health and social care needs, including those with severe and enduring mental health issues.

South Sefton PCN was involved in the development of the bid but said it was a collaborative effort.

Councillor Ian Moncur, cabinet member for adult social care and health at Sefton Council, said: ‘Through this programme, we will accelerate the development of neighbourhood-based care models that respond to the diverse needs of our communities—from supporting frail older adults to improving mental health services for young people.

‘Our goal is to make care more accessible, more personalised, and more effective—right where people live.’

Sefton place director Deborah Butcher added that the Council, ICB and partners have an ‘excellent track record of collaboration and integrated working’ and that the pilot will help to build on that.

In Hampshire and Isle of Wight, the ICB’s director of primary and local care, James Roach, also said the programme would bring this area ‘further support’ for local partners who are already working together with communities.

New contracts

Beyond the NNHIP programme, the new neighbourhood contracts are expected to come into force next year, however details have not yet been revealed by NHS England or the Department of Health and Social Care (DHSC).

Speaking at a Pulse PCN event in Newcastle earlier this month, Alison Oliver, commercial healthcare partner, and Catherine Hope, associate at law firm Sintons LLP, said that it was still unknown what impact the upcoming neighbourhood contracts would have on PCNs and the existing primary care contracts.

‘One of the things mentioned in the 10 year plan is the concept of a single neighbourhood provider contract,’ said Alison. ‘This would be a contract to deliver services across a neighbourhood, which of course is what PCNs are currently doing, providing services at that neighbourhood level.

‘What we don’t know is whether that single neighbourhood contract is intended to replace the DES or supplement the DES.’

She added that the 10 year plan called PCNs a ‘springboard’ for neighbourhood working, but that this does not necessarily mean that PCNs will be the holders of this contract.

‘One of the main risks for PCNs and practices is, if this the intention is that these contracts could be opened up to competition, how will it  affect PCNs going forward,’ she said.

‘We just don’t really know. It’s all a bit up in the air until we get some more detail. We also have the multi neighbourhood provider contract. Again, we don’t really know how that might impact on practices and PCNs. But clearly, we all need to kind of be thinking about what happens if the DES comes to an end, and what that might mean.’

Speaking in his capacity as GP in Tower Hamlets, rather than his newly appointed roles as RCGP president and member of NHS England’s board, Professor Sam Everington said it was important to deliver neighbourhoods on the basis of partnership and who is best to deliver it.

‘Across the country, the response needs to be very different,’ said Prof Everington. He gave the example of Tower Hamlets, where there is the wealth of Canary Wharf alongside high poverty, with lower life expectancy in women than men in some areas, particularly in Bangladeshi and Somalian populations.

He added that the shape of neighbourhoods would also depend on what other resources you have in the area, for example in Tower Hamlets the Council gave free swimming to all women over the age of 16 to try and tackle that life expectancy difference.

Tower Hamlets was one of the 141 applicants to the NNHIP programme, but wasn’t  chosen as one of the 43first wave sites. But it has already done a lot of work around integrated neighbourhood teams and the first ‘round the clock’ neighbourhood mental health centre opened there in July.

‘In a sense we’ve been doing it for years,’ says Prof Everington. ‘It very much fits in with the government agenda of shifting care out of the hospital.’

He added that relationships were ‘absolutely central’ to this next stage of the development of neighbourhoods.

‘The really exciting thing about the neighbourhood development is that it’s very organic and iterative and dependent on the relationships and the resources you have in certain areas,’ he said.

‘That can vary greatly, [and] the key thing to all of it though is that it [works] on delivering it on the basis of partnership and who is best to deliver it.’

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