The implementation of a neighbourhood health service and associated INTs across London’s region, five systems, and 32 places will require:

Clear leadership, support and accountability at all levels.

Within each place, partnerships will agree a lead organisation as host for the functions required to manage the transition and provide ongoing operational and delivery support to INTs. Addressing operational challenges, such as workforce capacity, data-sharing, and physical infrastructure, will be essential to ensure service continuity during transitions. Key functions for integrators will include identifying solutions to workforce variability and considering how interoperable digital tools can be deployed in ways that align with practical, local delivery; as well as managing the resourcing of neighbourhood teams alongside sustaining existing service delivery.

These functions cannot be delivered by any one organisation alone, but will require a core of organisational support and resourcing to deliver. In the absence of significant additional funding from outside of places and systems, such functions will need to harness existing assets and resources within our core community-based providers and teams.

As part of this development, we will ensure these organisations have the capacity to identify and support elements of the neighbourhood health service in distress including working with primary care partners to provide options to practices that are at risk of failure. This is not about taking over contracts or practices, but providing additional local options to mitigate the risks of failure and to coordinate a system response where support is required.

Strong and consistent leadership roles will be established at regional, system and place levels to provide oversight, alignment, and direction for transitioning to a neighbourhood health service. This includes agreeing Senior Responsible Officers (SROs) at each spatial level to navigate multi-agency change, supported by leadership development programmes to minimise disruption. Systems will consider how to balance strategic oversight with sufficient local autonomy to ensure transitions are responsive to local needs; as well as how to bring together clinical, professional and operational leadership at all levels.

Structured processes for managing change will reflect the need for a phased, co-designed change management approach. Existing place-based partnerships will provide the forum for collaborating on decision-making around resource allocation and service design, including identifying local priority areas and aligning with system and regional strategies.

Cultural alignment and collaboration across sectors will involve overcoming previous silos and legacies of competition and building trust between partners. This will be supported by targeted organisational development to embed collaborative practices and active engagement with VCFSEs and communities. Further exploration will be needed on sustaining this cultural change whilst empowering local voices in service planning.

Place partnerships will lead on measuring progress and continuous learning, in line with identified key metrics (as described further in the Metrics module of this operating model). Robust evaluation frameworks and continuous learning mechanisms are needed to monitor progress, identify challenges, and refine transition processes. Places will work with systems to embed rapid feedback loops that enable real-time adaptation, whilst ensuring shared accountability for outcomes across partners.

Development of infrastructure within each of our places to build neighbourhood operational capacity and enable local delivery.

We will invest in recruitment and training to address workforce gaps and build multidisciplinary capabilities. This will include exploring innovative solutions to workforce variability, such as shared staffing models or rotational programmes.

We will “draw down” data sharing and digital capabilities, including overcoming barriers through use of evolving London-wide architectures and local mandating of interoperable platforms that allow seamless access to information across INTs.

We will align physical and digital infrastructure across providers to support integrated neighbourhood working, including ensuring that local professionals and teams can access resources wherever they need them within neighbourhood footprints.

We will implement agreed, shared evaluation frameworks with clear, outcome-based metrics to track progress, focusing on leadership effectiveness, collaboration, and service integration.

Collaborative structures for shared learning and adaptation.

Structures will be established to accelerate change and enable consistency of progress across London based on:

• At a regional level: Shared forums for regional collaboration to disseminate best practice and align change efforts. The London Health and Care Partnership will provide overall leadership and support to the transition and to identifying opportunities and resolving shared issues across London’s five systems and 32 places.
• At a system level: London’s ICBs and Integrated Care Partnerships (ICPs) will work to align neighbourhood approaches with system-wide strategies, facilitate improved resource allocation, and streamline governance to avoid duplication or gaps in delivery. Systems will enable effective coordination whilst promoting local innovation.
• At a place level: Place based partnerships will drive the implementation of the neighbourhood health service through the development of INTs covering all parts of the population and prioritised within each age cohort based on evidence and data around population health inequalities and needs. Through the establishment of an integrator at place level, places will enable the implementation and operation of INTs across London, aligning local, system, regional and national assets and priorities.