Background
NHSE in their Neighbourhood Health guidelines 25/26 NHS England » Neighbourhood health guidelines 2025/26 state:
Neighbourhood health aims to create healthier communities, helping people of all ages live healthy, active and independent lives for as long as possible while improving their experience of health and social care, and increasing their agency in managing their own care. This will be achieved by better connecting and optimising health and care resource through 3 key shifts at the core of the government’s health mission:
- from hospital to community – providing better care close to or in people’s own homes, helping them to maintain their independence for as long as possible, only using hospitals when it is clinically necessary for their care
- from treatment to prevention – promoting health literacy, supporting early intervention and reducing health deterioration or avoidable exacerbations of ill health
- from analogue to digital – greater use of digital infrastructure and solutions to improve care
NHSE diagram showing the aims for all neighbourhoods over the next 5-10 years:
The Fuller Stocktake (NHS England » Next steps for integrating primary care: Fuller stocktake report) articulated the vision for ‘transforming primary care led by integrated neighbourhood teams that will be supported to lead change, drawing from the wealth of positive change already underway.’ By integrating primary and community care the aim is to bring together previously siloed teams to do things differently to improve patient care for whole populations. The Fuller Stocktake called for integrated neighbourhood ‘teams of teams’ to evolve from Primary Care Networks (PCNs), and be rooted in a sense of shared ownership for improving the health and wellbeing of the population.
The six core components of neighbourhood health are:
- Population health management
- Modern general practice
- Standardising community health services
- Neighbourhood multidisciplinary teams (MDTs)
- Integrated intermediate care with a ‘Home First’ approach
- Urgent neighbourhood services
What do we mean by ‘neighbourhoods’ in the context of neighbourhood health and INTs?
Neighbourhoods are usually considered to cover a population of around 30,000-50,000 people, which will typically be covered by a PCN footprint. The NHS confederation have written a report on ‘working better together in neighbourhoods’ Working better together in neighbourhoods | NHS Confederation and discussed how challenging it can be to fully define ‘neighbourhoods’.
The image below demonstrates how ‘neighbourhoods’ fit within an Integrated Care System (ICS).
What are Integrated Neighbourhood Teams (INTs)?
The Fuller Stocktake describes INTs as (NHS England » Next steps for integrating primary care: Fuller stocktake report):
At the heart of the new vision for integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations.
This is usually most powerful in neighbourhoods of 30-50,000, where teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams, and domiciliary and care staff can work together to share resources and information and form multidisciplinary teams (MDTs) dedicated to improving the health and wellbeing of a local community and tackling health inequalities.
Integrated neighbourhood ‘teams of teams’ need to evolve from Primary Care Networks (PCNs), and be rooted in a sense of shared ownership for improving the health and wellbeing of the population. They should promote a culture of collaboration and pride, create the time and space within these teams to problem solve together, and build relationships and trust between primary care and other system partners and communities.
This short video describes INTs
A Nuffield Blog https://www.nuffieldtrust.org.uk/news-item/integrated-neighbourhood-teams-lessons-from-a-decade-of-integration states INTs are intended to help by focusing on:
- streamlining access to care and advice to meet the needs of infrequent users of health care services
- providing more proactive, personalised and multi-disciplinary care for people with more complex needs
- helping people to stay well for longer, through a joined-up approach to
prevention.
What is going on in Gloucestershire in relation to Neighbourhood Health and Integrated Neighbourhood teams?
Integrated working at the Neighbourhood level in Gloucestershire builds upon many years of partnership working. Neighbourhood MDTs take place, focusing on the population of the GP registered list in each PCN footprint, with partners across health and care working more closely together around a cohort of people. To begin with, there is a particular focus on people living with moderate to severe frailty; supporting them to live and thrive in their communities for longer.
Case study
Below are details of what Aspen PCN, in conjunction with system partners, have been doing in relation to Integrated neighbourhood teams.
Resources:
NHS England » Neighbourhood health guidelines 2025/26
10 Year Health Plan for England: fit for the future – GOV.UK