Five questions every primary care leader should be asking about neighbourhood health
In a joint discussion paper, GGi Principal Consultant Simon Hall and Helen Northall, Chief Executive, PCC, argue that before creating new organisations or governance structures, primary care leaders should first answer some fundamental questions about purpose, leadership and accountability.
The NHS has a long history of believing that changing organisational structures will change the way people work. Every decade seems to produce another iteration of the health service: new organisations, new partnerships and new boundaries. Some have brought real improvements. Others have simply rearranged responsibilities without fundamentally changing how care is delivered. The move towards neighbourhood health creates a tremendous opportunity, but it risks falling into the same trap.
The NHS 10 Year Health Plan places neighbourhoods at the heart of future service delivery. Care is expected to move closer to people’s homes, organisations are expected to work more collaboratively, and primary care will increasingly be asked to play a leading role in improving outcomes for defined populations.
The temptation is to begin by asking what organisations should look like. Should PCNs incorporate? Should new provider organisations be established? How should neighbourhood providers hold contracts? They are reasonable questions. They are just not the first questions.
Our experience, combining PCC’s practical work with primary care organisations and GGi’s experience of governance and organisational development across the NHS, suggests that the organisations most likely to succeed will not necessarily be those with the most sophisticated legal structures. They will be those that develop the capability to work together effectively.
Put simply, function should determine form, not the other way round.
Five questions every neighbourhood should answer
1. Who can actually make decisions?
Many collaborations fail for a simple reason: everyone agrees, but nobody has the authority to commit their organisation.
Neighbourhoods need clarity about where decisions can be made, what authority representatives hold and how accountability operates across organisations. Without this, collaboration quickly becomes consultation.
2. What belongs at practice, neighbourhood and multi-neighbourhood provider level?
Not everything should happen within individual practices and not everything should be organised across large provider organisations.
General practice will continue to provide continuity of care and coordinate support for registered patients. Neighbourhoods create opportunities to organise community services, prevention and local partnerships differently. Some functions, such as urgent care, workforce development or business continuity, may be better organised across larger populations.
The starting point should always be the same question: what arrangement will produce the best outcomes for patients?
3. How do we lead when nobody is in charge?
Neighbourhood leadership depends less on hierarchy and more on influence.
It requires people who can build trust, work across organisational boundaries and balance the interests of individual organisations with those of the wider population.
Those skills do not just appear. They require deliberate investment in leadership development and organisational maturity.
4. How will we know whether we are succeeding?
As neighbourhoods mature, responsibility becomes shared. Outcomes, patient experience and operational performance increasingly depend upon organisations working together.
Neighbourhoods therefore need shared approaches to assurance, agreed outcomes, meaningful data and a willingness to learn collectively rather than simply monitoring performance organisation by organisation.
5. How will communities shape neighbourhoods?
Neighbourhood health will only succeed if services are designed with communities rather than simply delivered to them.
Primary care already has strong foundations to build upon through patient participation, social prescribing and local partnerships. The opportunity now is to combine those relationships with population health data, community organisations and local insight to ensure that neighbourhood priorities genuinely reflect the needs of local people and build on the strengths of local communities.
Building organisations, not simply structures
Perhaps the biggest challenge facing primary care is not deciding which organisational model to adopt but developing organisations capable of leading neighbourhood services.
Whether organisations eventually incorporate, utilise lead providers, become community interest companies or adopt other legal forms matters less than whether they have developed the leadership, governance and organisational capability to succeed.
Winning contracts is only the beginning. Organisations increasingly need to demonstrate strong governance, effective partnerships, quality assurance, confident leadership and the ability to work alongside integrated care boards, NHS providers and local authorities.
Strong organisations remain strong whatever structures emerge.
A joint offer from PCC and GGi
Neighbourhood health presents primary care with an opportunity not simply to respond to NHS reform but to help shape it.
PCC and GGi bring complementary expertise to support that journey. PCC contributes extensive practical experience of supporting practices, PCNs, federations and provider organisations to develop services, strengthen collaboration and navigate the realities of financial viability, as well as on leadership. GGi brings expertise in governance, organisational development, leadership , board effectiveness and neighbourhood health.
Together we can support organisations from their earliest conversations about collaboration through to becoming confident provider organisations. Our joint offer includes leadership and board development, governance reviews, neighbourhood development, organisational design and development, business planning, procurement and bid support, CQC readiness, contract development, and quality governance.
Neighbourhood health should not be viewed simply as another organisational reform. It is an opportunity for primary care to shape how care is delivered for the next generation. Those organisations that invest now in relationships, leadership, governance and organisational capability will not simply be ready for whatever structures emerge. They will help create them.
Authors: GGi Principal Consultant Simon Hall and Helen Northall, Chief Executive, PCC.