Within each of our place partnerships, there will be:

An agreed definition of the neighbourhoods that make up each place, based wherever possible on “natural” communities and boundaries recognisable to local people.

By “agreed” in this context, we mean agreed between health and local authority partners in each place in discussion with the voluntary and community sector, community representatives and other local public services.

Where it has not happened already, this will require meaningful co-design and engagement with local patients, residents, and health and care professionals. Such engagement will help to develop a shared view of existing local assets and priorities, and what a neighbourhood-based health and care service would mean for people living and working in the area.

A shared view of what we mean by a neighbourhood is required to enable further INT development and must strike a balance between the practicalities of delivery and the views of local communities. In discussions so far, definitions of what constitutes a neighbourhood have often been as varied as people themselves. There is a requirement to address potential overlaps and gaps that disrupt care delivery; create confusion amongst both professionals and citizens; and prevent equitable and effective resource allocation to population health needs. We will develop a set of consistent definitions of neighbourhood, but those definitions cannot simply be based on existing statutory boundaries or population sizes.

Where there is a lack of natural alignment, the definition of neighbourhoods for the purpose of INTs will be based on developing shared agreement of how assets, services and population health needs group within places; including how near or far away the existing footprints of local services are from subdivisions that work for all partners.

This will in turn require an understanding of capacity and demands within each place, for example, using population health data to identify specific population cohorts and priority needs; workforce and asset mapping, to build a clear picture of capacity, services and statutory, non-statutory and community assets (such as food banks, housing services and faith groups); and potential “hubs” within which to locate integrated service offers.

Place partners will ensure, within locally agreed minimum/maximum ranges, that neighbourhoods are balanced, including in terms of population size and needs, and access to relevant assets, support and services required to deliver for the associated communities. Whilst the 50,000 population level has been used previously within the NHS to describe neighbourhood working, the Target Operating Model allows for both larger and smaller footprints, depending on local circumstances.

We know that in London natural communities will not always fit neatly with existing administrative or geographic boundaries and definitions. This includes the current configuration of our PCNs, many of which are based on historic relationships between practices which are not necessarily related to geography or community needs.

INT boundaries in London will therefore not automatically be defined by PCN footprints. Where PCN boundaries align with recognisable neighbourhoods, the boundaries may be co-terminus. Where PCN boundaries do not align, PCNs will need to re-align to these geographies or develop local arrangements capable of operating effectively across more than one INT.

Once a consistent set of geographic neighbourhoods are agreed in each place, there will also need to be alignment to these from across acute, community, mental health, wider primary care and social services. This is not an exhaustive list, and nor is it intended to imply that every single professional in every one of these organisations will be incorporated into a single team – the successful development of INTs in London will be based on relationships as much as structures. However, professionals from across the full range of sectors and providers currently involved in health, care and wider local service delivery will need to be able to identify, and work together as colleagues around shared and defined objectives of addressing inequalities and improving population health and wellbeing for each neighbourhood through working more effectively with individuals and communities.

Recognition that even where there is existing alignment with how our statutory services operate today, there will be a need to manage flow across geographic boundaries.

In London as elsewhere in England, people may choose to be registered in practices which are in different neighbourhoods, places and/or systems to those where they live and work and receive other forms of healthcare. As such, the design of the future neighbourhood health service in London will need to start by understanding how services are being used by local people, and how this, in turn, is reflected in any future integrated models of neighbourhood and community-based care. This is even more important in communities which sit at geographic boundaries of one or more of our places and systems, both within London and into neighbouring ICSs, including not just flows out from London but flows into the capital; and boroughs where there are not currently a full range of acute/specialist services located within the geographic boundaries of that place.

The reality of patient mobility and specific feedback from Londoners themselves, highlights the need for more consistent mechanisms for Londoners accessing services and support (such as via the NHS App), which are not dependent on local arrangements or infrastructure being developed separately, but integrate seamlessly with all relevant local providers. This in turn requires mechanisms to ensure consistent management of patient flow across London as a whole, as part of a core offer of local health services which is available to all Londoners, irrespective of where they live, work or receive different types of care.

Consideration will be given at place level to the types of services which will continue to span neighbourhoods, and in some cases, systems in London. This involves recognising, for example, that traditional geographic definitions may not fully capture social and cultural dynamics that underpin effective engagement and outcomes. For instance, tailoring health services for specific cultural or ethnic groups will involve developing networks of collaboration between London’s neighbourhood teams, as well as targeted action within them.

The ability to plan, engage, and deliver at a hyper-local level.

London’s strength is our diversity. However, in every borough, there are pockets of affluence and pockets of deeply entrenched poverty, reflected in the high levels of health inequality experienced across the capital. Our place partnerships will need to be able to understand the population not just at a neighbourhood level, (where a neighbourhood, for INT purposes, could be at the 50,000+ population size), but down to Lower Layer Super Output Area (LSOA) level, where we will be working with communities of around 1,700 people. Local authorities are key partners in this.

Building this understanding includes reflecting the demographic make-up of the population within each geography, drivers of health and care needs such as age profile, socio-economic inequality, current health conditions and health and care related activity, (explored further in the Population Health Management module of this model), as well as wider determinants of health and wellbeing. A shared, data-driven approach is essential to ensure services and capacity of our future INTs align with local needs, where those needs can often be concealed in larger geographic units.

This will involve close local working between health, local authority and other partners to develop the level of quantitative and qualitative insight within each neighbourhood, including co-design with community leaders and communities themselves. The result should be an identified set of priority cohorts and tailored interventions within each neighbourhood, which takes our core offer for all Londoners and tailors and supplements this to reflect the communities who live, work and receive care there.

Periodic reviews of overall neighbourhood boundaries and footprints will be necessary to ensure they remain aligned with population changes and service demand. Evidence-based reviews of neighbourhood boundaries should be conducted periodically to reflect these changes, using population health insights, community engagement, and asset mapping to guide adjustments. In each system, we will establish and collect clear metrics for evaluating geographic alignment over time, including but not limited to service accessibility, health outcomes, and equity in service uptake. Further consideration is needed to explore the mechanisms and processes that would enable neighbourhood boundaries to adapt effectively without disrupting service delivery. This includes determining who holds responsibility for reviewing and approving changes and identifying how systems can collaborate with places to balance flexibility with operational consistency, at neighbourhood, place and system level.