Few ideas in the NHS attract such universal agreement as neighbourhood care.

Care closer to home is what we all want, when we need to access it. Services organised around a defined local population offer the greatest hope for population health - there’s endless compelling case studies, best practice examples and academic evaluations that tell us that. Teams that know and are based in, and look like, the communities they serve and can respond flexibly to need. It all sounds so obviously right that it barely feels like a choice at all.

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When an idea feels like a no brainer, it can be easy to fall into the assumption that we all understand it what it actually is, and the implementation often stops being thought through properly. The hard questions about feasibility, trade-offs, compromises and consequences are dismissed because ‘it’s obviously the right thing to do - people will get behind it’. Nowhere is that truer than with the neighbourhood concept.

Photo by Super Straho on Unsplash

Ask people around the system what a neighbourhood actually is and the lack of consistency is what stands out.

There is no single statutory definition of a “neighbourhood” in NHS policy documents, and different parts of the system describe it in overlapping or contradictory ways. It can be described as a population footprint, a set of services, a team, or a collaborative operating model. Some sources refer to rough population ranges; others emphasise community-defined boundaries. That variation is partly intentional (local flexibility) and partly a result of the concept evolving from multiple policy strands (PCNs, AHOs, left shift).

A quick search of ‘what is an NHS neighbourhood’ has brought up the following:

• A population footprint of roughly 30,000–50,000 people, often aligned to groups of GP practices (PCN-like).
Source: NHS England policy lineage via Primary Care Networks and early neighbourhood health framing; also summarised in explainer work by NHS Confederation.

• A locally defined geography based on “natural communities” that make sense to residents, rather than fixed administrative boundaries.
Source: NHS England London guidance on defining neighbourhoods, which explicitly avoids national templates and stresses local agreement.

• The footprint served by an Integrated Neighbourhood Team (INT), regardless of precise population size.
Source: NHS Confederation and National Association of Primary Care descriptions of neighbourhood working focused on multidisciplinary teams rather than boundaries.

• A functional unit of delivery rather than a fixed place — defined by how services collaborate rather than where lines are drawn.
Source: Nuffield Trust commentary on neighbourhood health teams, which frames neighbourhoods as an operating model, not a map.

• A sub-layer below “place” within Integrated Care Systems, sitting between PCNs and place-based partnerships.
Source: The King’s Fund system architecture analyses describing neighbourhoods as one tier in a multi-level operating model (system → place → neighbourhood).

• A delivery concept that bundles prevention, integration, personalised care, and community assets — without specifying size or governance.
Source: The King’s Fund long-reads questioning what “neighbourhood health” actually means in practice.

• A policy ambition rather than a technical definition — intentionally flexible to allow local interpretation.
Source: NHS England Neighbourhood Health Guidelines, which describe aims and principles but stop short of a formal definition.

• A political and narrative device used to signal a shift away from hospital-centric care.
Source: UK government announcements and speeches accompanying the NHS 10-Year Plan, which reference neighbourhoods aspirationally rather than operationally.

That lack of clarity and consistency undermines any neighbourhood ambitions. Because whatever the intention behind neighbourhood care, and whatever the agreed definition, it will not be the rhetoric that determines whether it succeeds, it will be the world it lands in. And that world is far from stable.

Photo by Zach Lezniewicz on Unsplash

Neighbourhood working is being introduced into a system that is financially constrained, operationally stretched, and increasingly risk conscious. A system still organised around organisational accountability, not shared outcomes. Where time for relationship-building is scarce, responsibility unclear, and where ambiguity is often treated as failure rather than an inevitable feature of complex work.

Neighbourhood care assumes alignment across organisations that are still judged separately, and are often still engaged in a competitive mindset, with stretched or even dysfunctional relationships. It assumes space for experimentation and psychological safety in environments designed for assurance. It assumes leaders who can work without clear lines of authority, negotiate trade-offs in public, and hold their nerve when progress is slow and contested. None of that is impossible, but none of it is easy either.

The risk is that because neighbourhood care feels so obviously right, we underestimate what it demands, and that’s how good ideas fail. Not because people disagree with the principle, but because people turn the idea into what it wants it to be without ever really changing or challenging themselves.

‘Neighbourhoods will be a success if everyone else changes the way they are working to suit me’.

Which is why the real question is not whether neighbourhood care is the right direction of travel. It is whether we are willing to confront what it actually requires of us as leaders.

Neighbourhood care will not succeed or fail on structure. It will succeed or fail on judgement. On how leaders navigate blurred accountability, competing incentives, and imperfect relationships.

That is why Harnessing NHS Leadership for the 10-Year Plan and Neighbourhood Care, convened by Health Cubed, feels like a timely and necessary conversation.

Not because it promises to provide us all with shared and agreed definitions of neighbourhoods, but because we can explore the gap between ambition and reality honestly. To talk about the world this idea is landing in, rather than the one we might wish for. And to focus on leadership behaviour as the limiting factor, and to think about how we might lead some of the change we need to see.

I’m chairing the event, and I’m looking forward to doing so for precisely that reason. As an opportunity to learn, to listen, and to connect with others grappling with the same complexity from different vantage points. And there are plenty of insightful views to listen to on the agenda.

If neighbourhood care is to become more than an attractive idea, we need fewer slogans and more serious thinking. We need to be better at finding clarity without pretending the complexity isn’t there.

And that’s a nice link to my developing work on The Prescription

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