Dr Johnny Marshall
NAPC Senior Leader
Andy Mullins
NAPC Faculty member and NNHIP coach
Neighbourhood health has been talked about for years. The ambition is well understood: care that is organised around people, places and communities rather than organisations and silos. But turning that aspiration into reality has always been the hard part.
In a recent NAPC Live session, Dr Johnny Marshall and Andy Mullins explored what is being learned through the National Neighbourhood Health Implementation Programme (NNHIP) and what that learning means for systems trying to make neighbourhood health work on the ground.
What emerged was not a new model or blueprint, but something arguably more important: insight into how change actually happens.
What is NNHIP and what makes it different?
NNHIP (mercifully shorter than its full title) is best described as a coaching and peer‑learning programme. It supports 43 sites across England to accelerate the development of neighbourhood health, a core feature of the NHS ten‑year plan.
Rather than prescribing a single model, the programme provides:
- Coaching support tailored to local context
- Space for peer learning across sites
- Shared infrastructure for capturing learning, barriers and enablers
- A feedback loop between local practice and national policy
After six months, every site has made progress and many are already demonstrating tangible impact. That alone is significant, but how that progress is being achieved matters just as much.
Balancing national direction with local reality
One of the enduring tensions in NHS transformation is the balance between national direction and local ownership. Too much instruction, and neighbourhood health becomes another centrally imposed initiative. Too little, and learning remains fragmented and hard to scale.
NNHIP actively works with this tension through a “loose–tight” approach:
- Loose on how neighbourhood health is delivered locally
- Tight on learning, evaluation, measurement and shared insight
Local teams are encouraged to build on their own strengths, relationships and histories. At the same time, the programme is clear about what needs to be consistent if learning is to travel across systems.
This approach will be familiar to NAPC members. For over two decades, through Primary Care Homes, Primary Care Networks and now neighbourhood health, NAPC has championed change as a social movement, not just a structural reform.
NNHIP represents an opportunity to scale that thinking nationally while still protecting its core ethos.
From Primary Care Homes to neighbourhood health: what really matters
Many of the principles underpinning neighbourhood health are not new. At its heart, neighbourhood health, like Primary Care Homes before it, is about:
Multi‑agency teams coming together to do the right thing for people they know in their communities, rather than the right thing for the organisations that employ them.
Where systems have struggled in the past is in rushing too quickly to contracts, structures and service models.
Evidence from NNHIP suggests that progress is not driven by organisational design, but by:
- Trust between professionals
- Strong relationships across agencies
- Willingness to experiment and learn together
The most successful neighbourhoods are not those with the neatest diagrams, but those where people know each other, back each other and create solutions collaboratively.
“We are all neighbourhoods”
Another key insight from the programme is the need for a mindset shift.
Neighbourhood health is often spoken about as something happening “over there” – a project, a team or a pilot. Acute providers may wonder when it will start affecting hospital flow. Social care may interpret it differently to health.
But the reality is simple:
We are all neighbourhoods.
Hospitals, local authorities, voluntary organisations, community services, primary care and even local employers all shape the health and wellbeing of populations. If neighbourhood health is treated as a separate initiative, it’s a signal the system is asking the wrong questions.
The right question is not “what are neighbourhood teams doing?”
It is “what are we doing to support our neighbourhoods?”
That shift matters because neighbourhood health is not primarily about medical care. Its long‑term impact lies in addressing the wider determinants of health: housing, loneliness, employment, wellbeing and community resilience.
Leadership: the foundation stone
Across NNHIP, one theme consistently stands out: leadership.
Neighbourhood health is not a service model. It is a way of working. That means success depends less on what leaders design and more on the conditions they create.
Effective systems are focusing on:
- Developing leaders at all levels, not just at the top
- Supporting shared, multi‑agency leadership at neighbourhood level
- Aligning board‑level behaviours with neighbourhood ambitions
A particular challenge lies in what some call the “squeezed middle” – managers caught between delivering the old system and building the new one. These leaders are often unintentionally positioned as blockers, when in reality they are the key enablers of transformation.
Supporting them is not optional. It is essential.
Sitting with discomfort and starting with communities
Transformation is hard because systems tend to snap back to what they know. When pressure mounts (financial, operational, political) there is a powerful pull toward familiar performance measures and short‑term fixes.
NNHIP sites making real progress are those willing to:
- Sit with discomfort
- Resist narrowing success to hospital flow alone
- Start with communities, not services
Instead of asking only about front‑door impact, they are asking:
- What matters to people locally?
- How are we working with local authorities and the voluntary sector?
- How are we addressing the root causes of demand?
These questions don’t always produce immediate results but over time, they are the only way to genuinely bend the curve.
Unlocking bottom‑up energy
A final challenge is energy. Frontline teams are under immense pressure and asking them to “do neighbourhood health” on top of everything else risks burning people out.
The lesson from NNHIP is clear: you have to invest in teams.
That means:
- Creating protected headspace for teams to work together
- Avoiding constant reorganisation without support
- Investing in teamwork, not just task allocation
- Using data and digital tools to reduce friction
When teams are given time and permission to talk, the results can be remarkable. Barriers that have existed for years are sometimes resolved in minutes- simply because the right people are finally in the same room.
A cautious optimism
So, is there reason to be hopeful?
Yes because momentum is building. More systems are recognising neighbourhood health as a whole‑system endeavour, not a primary care initiative in disguise. Local authorities and the voluntary sector are increasingly seen not as partners on the edge, but as central to success.
NNHIP is still at an early stage- the first rungs on a very tall ladder. But the direction of travel is clear.
Neighbourhood health works when we focus less on structures and more on people. When we start with communities. And when leaders at every level create the conditions for trust, collaboration and learning.
That may not be easy but it is finally starting to feel possible.
