Neighbourhood health needs a nuanced approach

In the wake of significant structural changes to NHS England, the emerging Neighbourhood Health framework presents both challenges and opportunities that demand careful consideration by PCNs.

A nuanced approach

We need to move past the simplistic narrative that PCNs must either lead neighbourhood teams or be consumed by them. Different contexts will call for different models:

• In some neighbourhoods, PCNs are well-positioned to lead integrated teams, particularly around frailty, long-term condition management, and preventative care
• In other contexts, such as complex mental health pathways or specialised children’s services, PCNs may create more value as supporting partners

This contextual approach allows us to be pragmatic rather than ideological.

What is the ask?

NHS England’s Neighbourhood Health Guidelines for 2025/26 are clear: neighbourhood teams should prioritise adults and children with complex health and social care needs requiring support from multiple services, including:

• Adults with moderate or severe frailty
• People with palliative or end-of-life care needs
• Adults with complex physical disabilities or multiple long-term conditions
• Children needing wider specialist input for physical and mental health
• High-intensity emergency department users

The goal is preventing unnecessary hospital stays, improving timely access to general practice, and preventing avoidable admissions to residential care—priorities that align with work many PCNs are already doing.

Navigating multiple barriers

Recent changes create significant practical challenges, including:

• Funding uncertainty: Limited clarity on how neighbourhood teams will be resourced
• Engagement capacity: Meaningful co-production demands significant time from already-stretched PCN leaders
• Form versus function confusion: Too much discussion about governance structures rather than service delivery models
• The foundation question: Integrated teams need PCNs with solid foundations, but many networks are still developing core functions
• The potential loss of ICB support: As ICBs reduce their workforce, valuable local expertise may disappear when PCNs need it most

Practical strategies for moving forward

Despite these challenges, PCNs can adopt several approaches to maintain momentum:

• Come prepared with data and insight: Showcase your population health analysis, priority cohorts, and successful interventions to position PCNs as informed partners
• Highlight existing integration successes: Document integration work already initiated through ARRS roles, social prescribing, or enhanced health in care homes
• Identify key ICB relationships: Focus on maintaining connections with the most critical ICB colleagues
• Form PCN coalitions: Create collective positions on neighbourhood health to strengthen your voice
• Strengthen local partnerships: While regional structures change, local relationships remain vital

Tailoring our approach to local needs

A one-size-fits-all approach won’t serve our communities well. Consider a tiered model of involvement based on PCN readiness. For example:

• Leading on areas where primary care brings unique value, such as long-term condition management or frailty
• Co-directing urgent community response with community trusts
• Supporting mental health initiatives where specialist trusts may take point
• Participating in integrated children’s services coordinated by local authorities

What’s critical is honest self-assessment about readiness. Taking on neighbourhood leadership without adequate capacity risks undermining both the PCN and the neighbourhood teams. Starting with a more limited but well-executed role can build credibility for greater involvement later.

Pragmatism over ideology

Debates about organisational positioning could distract us from the practical work of improving care for our communities. The questions that should guide our approach are about what arrangement best serves our patients: Where do PCNs add unique value? Where might others be better positioned to lead?

By focusing on these practical questions, we can help shape neighbourhood models that truly integrate care while preserving what works best in primary care – regardless of which organisation sits at the centre of the process.

Tara Humphrey is CEO of THC Primary Care, which provides interim management training to PCN leaders and has supported more than 120 PCNs.