London’s regional team, five systems, and associated place partnerships will adopt the following principles in the establishment and development of strong relationships between INTs and wider system providers:

We will work as systems and place partnerships to establish seamless collaboration across providers operating at neighbourhood, place and system level.

Supported by a place-based integrator, INTs will embed multi-disciplinary professionals from larger providers into neighbourhoods, with capacity-building initiatives to strengthen collaborative practices. Operational agreements will be designed to manage expectations around areas such as absence cover, professional standards, and cross-site working. This approach will eliminate inefficiencies, enable cohesive service delivery tailored to local needs, and ensure teams are equipped to work effectively across organisational boundaries. A core offer around services provided, and a core offer around what people can expect in relation to the coordination of those services will be critical to achieving this. The integrator will be linked into individual neighbourhoods and the wider place partnership in ensuring the infrastructure required to enable effective neighbourhood working.

We will apply proven population health management approaches to understand which specialist services are most relevant to specific populations and neighbourhoods. Using this data to inform targeted interventions can improve outcomes for currently underserved groups.

We will use existing and expanded place governance structures to bring together representatives from statutory services, VCFSE organisations, and community stakeholders in coordinated decision-making, shared accountability, and alignment of priorities in delivering neighbourhood health services. These structures, coordinated at place, should enable consistent application of policies whilst allowing flexibility to address local needs effectively, within the strategic commissioning frameworks already established at place.

We will promote integration by promoting co-location, where it makes sense including exploring opportunities within existing and recognisable neighbourhood “hubs” such as shared spaces for practices, housing, health, and VCFSE services. Through this, INTs will improve access and foster a cohesive experience for residents, as well as establishing the neighbourhood health service as something real and tangible for Londoners. Facilitating joint training and shared use of assets and resources will further enable professionals and local people to collaborate effectively within such co-located environments, ensuring these hubs function as integrated, responsive centres of care that feel “owned” by their communities.

We will adopt flexible approaches to staffing, ensuring that resources can be dynamically allocated to meet changing local needs. This will include enabling staff to work across multiple INTs or service areas where required, supported by clear operational frameworks that balance the needs of individual neighbourhoods with system-wide priorities.

A close relationship between specialists and primary care will support a transformation of the traditional outpatient model. Providing advice and support via a range of channels, case conferences and working within INTs will all be key enablers of this. Specialist input will also support improved population health management, prevention and proactive care.

Flexibility should also allow for tailored approaches that emphasise integration where it adds value, and collaboration where this is more appropriate. Maintaining the autonomy and agility of community organisations and VCFSE groups is critical to ensuring that these can continue to play an effective role as both a mediator and advocate for local individuals and communities. Similarly, the democratically accountable nature of local authority services within each borough, and the independent and entrepreneurial drive that characterises primary care in London, will be respected for the role these play in addressing local needs, preserving trust and developing relationships within communities.

We will agree a set of shared outcomes and measures of success in the context of local, system and regional priorities to support the development of these relationships.

We will define and align on common goals and metrics that reflect the priorities of all stakeholders, including our NHS providers, local authorities, VCFSE organisations, and local communities themselves. These shared outcomes should focus on improving health equity, service accessibility, and population wellbeing as our “Plan A” for addressing current and future service pressures and financial challenges. Regular joint monitoring and evaluation and transparent approaches to sharing progress and challenges across organisations will be required both to retain trust, and evidence the case for change within each of our neighbourhood service providers. Please see section 9 of this model for further details.

These changes will need to happen within a wider context, recognising the role of the Department of Work and Pensions, Department of Health and Social Care, and the Ministry of Housing, Communities and Local Government in enabling change. The London Health and Care Partnership which includes the NHS in London, London Councils, the Greater London Authority, Office for Health Improvement and Disparities, and UK Health Security Agency is currently involved in developing a new devolution proposal for London, which will include the need to ensure that barriers are addressed and resources can be moved to where they will have the biggest impact, for our babies, children and young people, families, for working age adults including those currently classed as economically inactive, and for our older population as well as those approaching the end of their lives.

Strategic estate planning will be a critical part of this change. This includes exploring opportunities to use the totality of our public estate in London, whoever currently owns or occupies this, to support the neighbourhood health agenda; and ensuring that co-located hubs are designed with input from communities to ensure they meet local needs. It includes ensuring that developers engage with neighbourhood health and wellbeing priorities and plans, working with local authority planning colleagues.

This will not work without effective infrastructure for data sharing and collaboration. We believe neighbourhoods are the appropriate scale to deliver effectively targeted support to people at each stage of their lives; but to enable this will require interoperable IT systems and standardised data-sharing agreements which enable real-time decision-making and coordinated care to be developed across places, systems and the London region as a whole. Without this, we will be unable either to deliver care in the most efficient and effective way possible, or to evidence the outcomes of improvements in the way in which such care is delivered in future. As ICSs and a region, we will work with developers to ensure that the future roadmap for digital system development reflects the needs of neighbourhood teams.

Where areas are already showing progress, we will strengthen mechanisms for sharing best practice across neighbourhoods and places. This includes ensuring within each place and system and across our region that learning is available and emerging evidence used to support the scaling and spreading of “what works” in neighbourhood health and care, replacing ad hoc workshops, research and evaluation projects and events with a systematised approach through place-based integration functions, which are embedded into local operational delivery and accountability.

We will build on existing neighbourhood foundations.

INTs in London do not have to start from scratch. Community-based provider organisations and voluntary, community and faith groups have long been at the forefront of building trusted relationships, responding to local needs, and driving community-led initiatives. The strength of this approach was evidenced through London’s pandemic response. Instead of duplicating these efforts, we will focus our place partnerships and emerging INTs on fostering collaboration between statutory services, professionals and these established groups to maximise collective impact.

Current perceived or actual power imbalances will be addressed. This includes those between statutory services, community-based provider organisations, and VCFSE groups, through:

• Ensuring there is sufficient representation of VCFSE and community groups in decision-making forums including co-developing governance structures with shared ownership.
• Creating the conditions to enable VCFSE groups and community members to lead interventions where their expertise and lived experience are critical. This may involve shifting resources or developing new structures and forums to better understand what this might look like, and mechanisms to enable a robust response to any barriers. It will involve working with VCFSE partners to understand the best way of engaging and bringing together existing local organisations, often working at a hyper-local level, to support neighbourhoods and community transformation at scale.
• Fostering inclusive involvement and representation with participation from a diverse range of organisations, from large providers to smaller, grassroots groups deeply embedded in their communities. Special attention will be given to involving under-represented groups, particularly in deprived areas or those with limited or degraded community infrastructure. Developing mechanisms to engage local services and groups such as schools, social care providers, and faith-based organisations, will ensure that the full breadth of neighbourhood and community assets is mobilised.
• Involve communities in planning and service design to ensure that evolving local needs are identified and met and that diverse voices continue to contribute meaningfully to the conversation. Processes for identifying and addressing gaps or overlaps in services will be co-developed with stakeholders to promote iterative improvement. This includes the process of establishing INTs covering every community in London.
• Identify and build upon existing assets and resources within communities. For example, through consistently applying an Asset-Based Community Development (ABCD) approach, partnerships will focus on mobilising local strengths, such as community relationships, physical infrastructure, and shared knowledge, to deliver tailored solutions for those communities.