This article by PCC chair Professor David Colin-Thomé, chair of PCC, and Professor James Kingsland considers the conditions to develop neighbourhood health, based on their experience working in the North East region.
The NHS England North West Neighbourhood Development Programme has been established to support the practical development of neighbourhood health systems across the region. At a time when the NHS is embracing neighbourhood health as a central component of the government’s 10 Year Health Plan, the programme provides an important opportunity to explore how neighbourhoods evolve in real-world settings, understand the barriers they encounter, and identify the conditions that enable successful transformation.
Unlike many national initiatives, participation in the NHS England North West Neighbourhood Development Programme was not determined through a complex competitive selection process. Whilst some neighbourhoods had previously expressed an interest in the National Neighbourhood Health Implementation Programme, this initiative adopted a different approach.
Expressions of Interest were invited from neighbourhood teams across the region, with selection based not on organisational maturity or existing performance, but on the enthusiasm, commitment and ambition of those delivering care on the frontline. Particular emphasis was placed on clinically led teams that demonstrated a genuine desire to improve neighbourhood health, develop innovative approaches to care, and critically evaluate and measure the impact of their work.
Recognising the considerable potential within these local systems, NHS England North West secured modest funding to establish an innovative mentoring and collaborative learning programme that would nurture local leadership, accelerate learning and support neighbourhood development across the participating sites.
The programme was conceived by Professor James Kingsland, former GP and longstanding advocate of integrated primary care, working alongside an experienced multidisciplinary faculty of national leaders. The mentoring team, including Professor David Colin-Thomé, former national clinical director for primary care together with colleagues from across primary care, public health, nursing and organisational development, have volunteered their expertise on a largely pro bono basis. Their shared motivation reflects a collective commitment to supporting the ambitions of the government’s 10-Year Health Plan despite the significant financial constraints currently facing the NHS.
A different model of improvement
Traditional NHS improvement programmes have often relied upon centrally directed, performance-driven approaches. Whilst these can provide clarity of purpose, they can sometimes struggle to engage frontline clinicians and local leaders who ultimately determine whether change succeeds.
The North West programme has therefore adopted a fundamentally different philosophy.
Rather than focusing on performance management, it is built around trust, mentorship, peer learning and collaborative system development. The programme recognises that neighbourhood health cannot simply be implemented through organisational redesign or structural change. Successful neighbourhoods emerge through the development of trusted relationships, shared leadership, clinical engagement and collective ownership of population health.
Albeit a newly designed programme the philosophy draws upon learning from the nationally recognised Complete Care Community Programme, also led by Professor Kingsland, which demonstrated that sustainable integrated care depends less upon organisational structures and more upon the quality of relationships between organisations, professionals and communities.
The programme identified several essential foundations for successful neighbourhood development:
- strong inter-organisational governance with clear accountability and shared responsibility;
- financial stability and long-term investment in collaborative capacity;
- organisational structures that encourage collaboration rather than competition;
- continuous learning, communication and team development;
- genuine horizontal engagement between professionals, voluntary organisations and local communities;
- trust-based relationships built upon shared values and mutual respect;
- a collectively owned long-term vision for neighbourhood health; and
- collaborative leadership that prioritises system success above organisational interests while recognising that transformation is rarely linear.
These principles now underpin the North West Neighbourhood Development Programme.
Learning rather than judging
A defining feature of the programme is that it is intentionally developmental rather than regulatory.
The objective is not to assess, rank or performance-manage neighbourhoods, but to understand how neighbourhood systems develop, what challenges they experience, and what practical lessons can be shared across the wider NHS.
The programme therefore operates around four simple principles:
Learning rather than performance management
The emphasis is on understanding neighbourhood development rather than measuring compliance.
Light-touch integration
Learning is captured through existing mentoring conversations, avoiding unnecessary administrative burden for local teams.
Consistency across neighbourhoods
A common framework enables themes, barriers and successful innovations to be recognised across participating sites while respecting local variation.
Practical application
Insights generated during the programme directly inform mentoring discussions, regional learning summaries and the final synthesis of neighbourhood development across the North West.
The approach is deliberately proportionate and non-bureaucratic, reflecting the programme’s belief that meaningful learning should support, rather than distract from, local service transformation.
Capturing learning in real time
The programme uses a straightforward monthly learning cycle consisting of three complementary elements:
- neighbourhood pre-meeting reflections;
- structured monthly mentoring conversations; and
- facilitator reflections following each session.
Together these provide a consistent evidence base that captures both the technical and relational aspects of neighbourhood development.
To provide a shared language for reflection, mentors utilise the CHART Track framework. Rather than serving as an assessment instrument, CHART Track offers a developmental framework across five domains:
- Connections and relationships
- How care works in practice
- Access and experience
- Reflection and learning
- Transformation and sustainability
This enables neighbourhoods to reflect on their own progress while allowing programme-wide learning to be synthesised consistently across all participating sites.
Relationships before structures
One of the most striking observations emerging from the mentoring programme has been the enthusiasm, creativity and commitment demonstrated by neighbourhood teams.
Each participating neighbourhood is supported by a multidisciplinary mentoring “teamlet” comprising three experienced mentors. Although neighbourhoods naturally progress at different rates, mentors consistently report high levels of professional commitment, innovative thinking and a genuine desire to improve outcomes for local populations.
Perhaps the greatest lesson emerging so far is that successful neighbourhood health is fundamentally relational rather than structural.
For many decades the NHS has evolved through organisational redesign, structural reform and centrally directed change. Neighbourhood health requires a different way of working—one that depends upon trust, distributed clinical leadership, shared learning and collaborative relationships across organisational boundaries.
The role of mentorship is therefore not to provide answers, but to create the conditions in which local leaders can discover their own solutions, build confidence, develop relationships and accelerate learning.
Looking forward
The government’s 10-Year Health Plan presents one of the most significant opportunities for neighbourhood health in a generation. Realising that ambition will depend not only upon national policy but upon thousands of clinicians, community organisations, local authorities and citizens working together differently.
The NHS England North West Neighbourhood Development Programme demonstrates that meaningful transformation does not require large-scale investment or extensive bureaucracy. With modest resources, experienced mentorship and a culture of trust, local neighbourhoods can generate remarkable energy, innovation and commitment.
As the programme continues, it will provide an increasingly rich body of practical evidence describing how neighbourhood health develops in practice. Perhaps more importantly, it demonstrates that sustainable change is achieved not through command and control, but through relationships, shared purpose and collaborative learning.
If neighbourhood health is to become the future operating model of the NHS, then developing trusting partnerships, nurturing clinical leadership and creating opportunities for collective learning may prove to be just as important as organisational reform itself.
Authors
Professor James Kingsland and Professor David Colin-Thomé.
