Doing with,
not for

Neighbourhood health is becoming one of the defining ambitions of NHS transformation. Across England, health and care organisations are considering how services might work more closely together around the communities they serve.

However, there is a danger that we mistake organisational change for meaningful transformation. We can draw new boundaries, establish new boards and create new teams without necessarily improving the experience of patients.

The more important question is not simply how neighbourhoods should be structured, but who they are being designed for and who is involved in shaping them.

A recent paper by Robin Miller, Michelle Nelson and Fraser Battye explores this challenge directly. In How Does Integrated Care Do With, Not for, Neighbourhoods & Communities?, the authors consider what authentic neighbourhood working requires and why it demands more than reorganising existing services.

Their reflections have particular relevance for East Staffordshire and, especially, for how we approach the future of neighbourhood health in Burton.

A neighbourhood is not the same as a community

One of the paper’s most important observations is that neighbourhoods and communities are related but distinct.

A neighbourhood is usually defined by geography. It reflects where people live, access local services and go about their daily lives.

A community, however, is defined by relationships. It may develop around shared experiences, cultural identity, faith, employment, family connections or mutual support.

Several communities can exist within the same neighbourhood. Equally, a person’s most meaningful community may extend well beyond the area in which they live.

This distinction matters because it challenges the assumption that drawing a boundary automatically creates a coherent community.

For neighbourhood working to succeed, we must understand not only where people live, but also how they connect, where they seek support and whom they trust.

What this means for Burton

Burton has a clear geographical identity. There is a reasonable argument for considering the town as a coherent strategic neighbourhood within the wider East Staffordshire landscape.

However, Burton is not a uniform population.

Across the town, people experience different levels of deprivation, housing insecurity, long-term illness, social isolation and access to support. There are also differences in cultural background, community networks and the organisations through which residents feel connected.

The surrounding villages have their own identities, strengths and challenges, including issues associated with distance, transport and access to services. These differences should not be overlooked by imposing a single model across the whole of East Staffordshire.

For Burton itself, a possible approach would be to recognise the town as one strategic geographical entity while developing two locally focused integrated health teams.

Such an arrangement could provide a shared direction for Burton while preserving the practical benefits of smaller teams, local clinical leadership and closer relationships with the communities they serve.

The geographical footprint would provide coherence. The integrated health teams would provide responsiveness.

Importantly, this is not an argument for adding unnecessary complexity. It is an attempt to ensure that the scale of strategic organisation does not overwhelm the local relationships on which effective care depends.

Starting with what already exists

The authors argue that neighbourhood working should build around places and relationships that already matter to local people.

These might include schools, libraries, pharmacies, faith institutions, community centres, sports organisations and voluntary groups.

The significance of this argument is that integration does not necessarily begin with a new building or another organisational structure. It begins by recognising the assets and relationships that already exist within a community.

In Burton, that means looking beyond NHS organisations alone. Local pharmacies, carers’ groups, faith communities, schools, housing services, social care providers and organisations such as Burton Albion Community Trust may all have a valuable contribution to make.

Many of these organisations already understand the pressures facing local people. They may recognise social isolation, financial hardship, poor housing or barriers to accessing care long before those difficulties appear in a formal healthcare assessment.

If they are brought into the conversation only after a model has already been designed, we miss an important opportunity.

Neighbourhood health should not simply deliver services to communities. It should be shaped through an ongoing relationship with them.

From multidisciplinary working to an integrated health team

At Carlton Group Practice, our existing multidisciplinary meetings and care coordination arrangements have given us a practical understanding of how different professionals can work together around patients with complex needs.

We have seen the value of bringing together clinical knowledge, continuity of care and the insights of colleagues who understand the wider circumstances of a person’s life.

However, an integrated health team should be more than an enlarged multidisciplinary meeting.

It should have a defined population, a clear understanding of local need and the ability to identify people who would benefit from coordinated support. It should bring together general practice, community services, mental health, social care and voluntary sector partners.

Crucially, it should also have access to specialist advice and the ability to act on the decisions made.

The role of care coordination is central. Someone must ensure that actions are followed up, information is shared appropriately and the patient does not become lost between services.

Without this practical coordination, integration risks becoming a discussion rather than an intervention.

The challenge for Burton is therefore not to invent neighbourhood working from the beginning. It is to identify what already works, strengthen those foundations and connect them more effectively across the system.

General practice can lead, but it cannot do this alone

General practice has an important leadership role within neighbourhood health.

GPs often hold long-standing relationships with patients and families. We understand the interaction between physical illness, mental health, social pressures and the wider circumstances in which people live.

We also see the consequences when care becomes fragmented.

However, clinical leadership from general practice should not mean that practices are expected to deliver the entire neighbourhood agenda alone.

The paper makes clear that neighbourhood working must be a whole-system responsibility. Community providers, hospitals, commissioners, local authorities and voluntary organisations all have a part to play.

In East Staffordshire, this means developing constructive relationships between general practice, Midlands Partnership University NHS Foundation Trust, University Hospitals of Derby and Burton, the integrated care board and community partners.

Each organisation brings different expertise and resources. The objective should be to make those contributions complementary rather than competitive.

The question is not which organisation controls the neighbourhood. The question is how organisations can work together to improve the lives of the people living within it.

Addressing power and resources

One of the most challenging themes in the paper is the imbalance of power between organisations.

Health systems can speak confidently about collaboration while continuing to concentrate decision-making, funding and influence within established institutions.

Voluntary organisations may be invited to contribute but lack the resources to participate fully. Frontline clinicians may be expected to develop new pathways without protected time or adequate operational support.

These arrangements are difficult to sustain.

If neighbourhood health is to become meaningful, investment must support the work that makes integration possible. This includes clinical leadership, care coordination, community engagement, population health analysis and the contribution of voluntary and community partners.

The principle is straightforward: resources should support the places and relationships where improved outcomes are being created.

Collaboration is not sustained through goodwill alone. It requires the time, capacity and trust that allow partners to contribute meaningfully.

Measuring outcomes that matter

Another important argument in the paper concerns how success is measured.

Different organisations are frequently judged against separate targets. Hospitals focus on activity and waiting times. General practice manages access and contractual requirements. Community providers work within their own service specifications.

These measures have value, but they do not always reflect whether care feels coordinated from the patient’s perspective.

A neighbourhood approach should encourage us to consider shared outcomes.

For Burton, these might include earlier recognition of frailty and complex long-term conditions, fewer avoidable hospital admissions, improved continuity of care, better patient experience and more effective support for people living with overlapping social and medical needs.

They should also include a reduction in health inequalities and improved access for communities that have historically found services difficult to navigate.

The emerging outcomes framework offers an opportunity to move beyond counting activity and begin asking whether the system is making a tangible difference to people’s lives.

The most important question remains a simple one: does care feel more joined up to the person receiving it?

Equity cannot be assumed

The authors also raise an important warning.

Neighbourhood initiatives can unintentionally increase inequality if the most confident, well-connected or better-resourced communities are more able to influence decisions.

Those experiencing the greatest disadvantage may have the least time, flexibility or opportunity to participate in conventional engagement exercises.

For Burton, this means that reducing inequality must be built into the model from the beginning.

Population health information should be considered alongside the knowledge of frontline teams, community organisations and residents themselves. Engagement must take place in accessible settings and through trusted local relationships.

We should not assume that inviting people to a meeting is the same as hearing the voices of those most affected.

Equity requires deliberate effort. It does not emerge automatically from a new organisational structure.

The real test for East Staffordshire

The central lesson from this paper is that neighbourhood health is not principally about maps, contracts or organisational charts.

It is about understanding place, recognising relationships and bringing together the people who can make a meaningful difference.

For East Staffordshire, the challenge is to develop neighbourhood arrangements that reflect the differences between Burton and the surrounding villages while remaining sensitive to the diversity within Burton itself.

For Burton, that may mean a shared strategic identity supported by locally focused integrated health teams and distributed clinical leadership.

For organisations across the system, it means recognising that integration requires shared responsibility, aligned resources and a willingness to work beyond traditional boundaries.

For those of us in general practice, it means continuing to advocate for a model that is clinically grounded, community informed and focused on patient outcomes.

Ultimately, the success of neighbourhood health will not be determined by whether we create the right structure on paper.

It will be determined by whether patients experience better care, whether professionals work together more effectively and whether communities feel that the system is listening.