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Delivering integrated neighbourhood services: commissioning and service design

Interim findings on how commissioning processes and service design at Place level support delivery of integrated neighbourhood health and care services in England.

Key messages

  • current policy emphasises Place-level commissioning to support more integrated health and social care at neighbourhood scale, aligning with the 10 Year Health Plan’s shift towards community-based care
  • Places are intended to be sub-Integrated Care Boards (ICB) geographies where integrated services are planned and delivered around local populations
  • commissioning responsibilities were delegated through the Health and Care Act 2022 without prescriptive structures, leading to variation in local approaches to Place-level commissioning
  • literature suggests factors that enable effective Place-level commissioning include clear governance, strong relationships, shared priorities, workforce capacity, pooled resources and collaborative planning
  • there are recurring tensions between integration aspirations and the legacy organisational, structural and policy divides that continue to shape commissioning practice.

Policy implications

  • commissioning systems need clarity on how responsibilities at Place level sit within wider Integrated Care Systems (ICS) structures
  • effective neighbourhood health and care depends on governance arrangements that support collaboration rather than siloed action
  • workforce development, information sharing and resource alignment should be prioritised in commissioning design
  • national policy should continue to support local adaptation while providing frameworks that encourage consistency in integrated commissioning.

Gaps

  • limited empirical evidence on how Place-level commissioning directly affects integrated service delivery outcomes
  • variation in how neighbourhood and Place commissioning has been interpreted complicates comparison across local sites
  • much of the evidence is early and descriptive, with limited long-term evaluation of integrated neighbourhood initiatives.

Commentary
This interim report provides early insights into how commissioning and service design are shaping integrated neighbourhood health and care in England. By focusing on Place-level mechanisms, it highlights how national policy intentions are being interpreted and operationalised in local systems.

The shift towards neighbourhood-based integrated commissioning is situated within broader NHS reforms, including the 10 Year Health Plan and statutory establishment of Integrated Care Systems (ICS). In this context, Place offers a scale at which health and social care services can be joined up around people’s needs rather than organisational boundaries.

Key enabling factors identified in the literature signal that commissioning for integrated neighbourhood care requires more than structural arrangements; it depends on trust, shared priorities, effective governance and aligned incentives. These relational and organisational elements mirror themes seen in other neighbourhood health evidence that integration is as much cultural as structural.

However, the report also underscores the early and uneven nature of Place-level commissioning practice. With permissive policy frameworks and variable local interpretation, there is a risk that integrated neighbourhood services remain patchy in reach and impact. Strengthening evidence on what works, for whom, and in what contexts will be essential to ensure that neighbourhood health and care contributes to equity rather than reproducing existing disparities.

Primary care networks and place-based working during COVID-19

A report examining how Primary Care Networks can address health inequalities through place-based working, with a focus on learning from the COVID-19 pandemic.

Key messages

  • Primary Care Networks (PNCs) are well positioned to address health inequalities through place-based approaches
  • COVID-19 exposed and intensified existing health inequalities, highlighting the importance of local action
  • collaboration with local authorities, voluntary organisations and community groups is central to effective place-based working
  • PCNs can use local knowledge and population health data to identify and respond to unmet need
  • flexible, locally tailored responses were critical during the pandemic.

Policy implications

  • neighbourhood health and care approaches should strengthen the role of PCNs as local system convenors
  • place-based working requires support for partnership development beyond primary care
  • population health data should be used to target resources and interventions more effectively
  • lessons from COVID-19 can inform more resilient and equitable neighbourhood models.

Gaps

  • evidence is largely descriptive and based on pandemic-era experience
  • limited evaluation of long-term impacts of PCN-led place-based approaches
  • lack of systematic comparison across different PCNs and localities.

Commentary
This report highlights the role of PCNs in advancing neighbourhood health and care through place-based working. During the COVID-19 pandemic, PCNs were often at the centre of local responses, coordinating with councils, voluntary organisations and community groups to reach vulnerable populations.

From a care equity perspective, the report shows how local knowledge and relationships enabled targeted responses to inequalities that were not easily addressed through national approaches alone. Flexible delivery models and partnership working helped PCNs adapt services to local need.

The pandemic context also revealed structural challenges. Variability in capacity, data access and partnership maturity affected how effectively PCNs could respond, raising questions about consistency and sustainability beyond emergency conditions.

Overall, the report suggests that PCNs can play a key role in neighbourhood health and care, but their ability to address inequalities depends on strong place-based partnerships, access to data and ongoing system support. Embedding these lessons into routine practice is central to reducing health inequalities over time.

The Marmot Review: 10 years on

A national review assessing progress in reducing health inequalities in England ten years after Fair Society, Healthy Lives.

Key messages

  • health inequalities in England have widened rather than narrowed over the past decade
  • life expectancy improvements have stalled, with declines observed in some groups and areas
  • health outcomes closely follow a social gradient linked to deprivation
  • inequalities are strongly shaped by social, economic and environmental conditions
  • action across multiple sectors and levels of government is required to address inequalities.

Policy implications

  • neighbourhood health and care approaches must address wider social determinants, not only healthcare access
  • place-based action is critical to tackling inequalities driven by local deprivation
  • prevention and early intervention should be prioritised across the life course
  • sustained national and local commitment is needed to reduce health inequalities.

Gaps

  • limited evidence of effective large-scale policy action to reverse widening inequalities
  • insufficient progress in embedding equity across all policy areas
  • lack of accountability mechanisms to ensure action on social determinants.

Commentary
This review provides a critical backdrop for neighbourhood health and care policy. By showing that health inequalities have worsened over the decade following the original Marmot Review, it stresses the limitations of approaches that focus narrowly on healthcare delivery alone.

The findings reinforce the importance of place-based action. Neighbourhoods shape exposure to poverty, housing quality, employment opportunities and social connection, all of which influence health outcomes. From a care equity perspective, neighbourhood health and care offers a potential mechanism for acting on these determinants locally.

However, the review also highlights that local action cannot substitute for national policy. Without sufficient investment and cross-government commitment, neighbourhood initiatives risk operating in contexts where inequalities continue to deepen.

Overall, The Marmot Review 10 Years On strengthens the case for neighbourhood health and care that is explicitly equity-focused, prevention-oriented and connected to wider social and economic policy. Without this alignment, neighbourhood approaches are unlikely to reverse entrenched health inequalities.

Workforce lessons from neighbourhood integration

Programme learning on how local areas have addressed workforce challenges in delivering integrated care at neighbourhood level.

Key messages

  • successful neighbourhood integration relies on strong cross-sector relationships and shared leadership
  • co-located teams help reduce workforce fragmentation and improve coordination
  • joint governance arrangements, including shared decision-making and pooled budgets, enable more responsive services
  • shared working practices based on trust, co-production and common protocols support consistent, person-centred care
  • learning draws on case studies from Haringey and Islington, Leeds, Luton and Norfolk.

Policy implications

  • neighbourhood integration requires investment in relationship-building as well as structural change
  • governance models that support joint accountability may improve pace and flexibility of delivery
  • workforce strategies should support co-location and shared practice across organisational boundaries
  • long-term investment is needed to sustain neighbourhood-level integration.

Gaps

  • limited evidence on long-term workforce outcomes from neighbourhood integration
  • lack of consistent evaluation across different local models
  • limited insight into how workforce integration affects inequalities in access and experience.

Commentary
This programme learning highlights workforce integration as a central enabler of neighbourhood-level care. Strong relationships across health, social care and community organisations underpin the ability to deliver integrated, person-centred services.

Co-located teams and shared leadership arrangements are identified as practical mechanisms for overcoming workforce fragmentation. From a care equity perspective, these approaches can improve continuity and responsiveness, particularly for people with complex or multiple needs.

However, the findings also point to structural risks. Short-term and inconsistent funding, fragmented data sharing and limited investment in community infrastructure constrain the sustainability of neighbourhood integration efforts. These barriers may disproportionately affect deprived areas, where services are already under pressure.

The learning also raises important equity considerations around trust. High levels of integration with statutory services can risk weakening the independence and trust of community-led organisations if not carefully managed. In neighbourhoods where communities have historically felt let down by formal systems, this may undermine engagement rather than strengthen it.

Overall, the evidence suggests that neighbourhood integration depends as much on relational and cultural factors as on formal structures. Ensuring that workforce integration supports, rather than displaces, community leadership is likely to be critical for delivering equitable neighbourhood health and care.