The major challenges of poor health and wellbeing, persistent inequalities and dissatisfaction amongst staff and patients, require urgent action and a change in the way that different parts of the health and care system work with each other and the wider community.

Representatives of London’s five ICSs and place based partnerships; NHS and non-NHS providers; the NHS England Regional team; London Councils; the Greater London Authority; the Office for Health Improvement and Disparities; the UK Health Security Agency; together with partners such as the Londonwide Local Medical Committees, have been convening since the summer of 2024 in the context of national developments including:

• The Fuller Stocktake Report (2022) and subsequent work on the future of primary care, sets out a vision of streamlined access to care and advice, with more choice and availability in the communities where people live; more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs, including but not limited to those with multiple long-term conditions; and a joined-up approach to prevention, helping people to stay well for longer. These developments were encapsulated in the Stocktake within the concept of an “Integrated Neighbourhood Team” (INT), building on existing successful models of person and community-centred care across England.
• The Independent Investigation of the NHS in England by Lord Darzi (2024) sets out the growing challenges for the health service in England, including the impact of wider determinants of health in driving rising demand for healthcare services; the prevalence of long-term health conditions across age groups, and of mental health needs particularly affecting children and young people; and the erosion of public trust resulting from rising waits for access to GPs, community and mental health services, urgent and emergency and elective care.
• The Manifesto Commitments of the new Government (2024) to “Build an NHS fit for the future” is exemplified by a move to a neighbourhood health service with reinvigorated primary and community services at its heart, enabled by a shift of resources and focus from hospital to community, from analogue to digital, and from treatment to prevention.

The purpose of this document is not to repeat the national case for change, but to establish a shared understanding of what this means in the context of the health and wellbeing of nine million Londoners.

Where relevant, we reference broader developments and context, but specifically, this document is about identifying priorities locally, and understanding how London can help support and shape national developments across health and care, in the interest of the population as a whole.

Over recent years, including since the establishment of statutory ICSs in London, and the publication of the Fuller Stocktake in 2022, there has been much work at place, system and regional level in London to develop better integrated, person and community centred care, supporting improved health and wellbeing, and more sustainable health and care systems.

There is still much to do in working out how neighbourhood health and care services will operate in practice, informed by the problems they will need to address, and the opportunities to deliver better health and wellbeing. This includes through improved access, better support for vulnerable people and those living with complex health and care needs, enhanced investment, engagement and uptake across all stages of prevention, tackling health and wider socio-economic inequalities, and contributing to economic growth. Where better outcomes can be achieved, many of the changes that are needed are only achievable through a multidisciplinary and multiagency approach across a wider range of health, local government and broader services.

However, as this case for change highlights, the experience of implementing multidisciplinary working nationally and in London, is that simply bringing together professionals around a shared care plan and specific cohorts of patients is not going to be enough.

In setting out this case, we describe both the drivers which led us in London to a position where the status quo is not sustainable, and the opportunities that arise from the development of INTs across London, in a consistent way, building on existing resources, assets and best-practice, as a key part of building a better future.