Integrated Neighbourhood Teams: Why Co-Location Isn’t Boundary Governance

This is the fifth article in a series examining the boundary between local authority social care and the NHS. The first article established the constitutional domain gap. The second examined what happens when both sides reorganise simultaneously. The third showed that 28.2% of delayed discharge is caused by “interface processes.” The fourth revealed the structural asymmetry in data infrastructure across the boundary. This article examines why the 10 Year Health Plan’s centrepiece reform depends on exactly the crossing that this series shows does not work.

In September 2025, the government announced the 43 sites selected for the first wave of the National Neighbourhood Health Implementation Programme. Backed by £10 million, prioritising areas with the lowest healthy life expectancy and longest waits, the programme is the operational beginning of what the 10 Year Health Plan calls the “left shift” — moving care from hospitals to communities. More than 80% of places in England applied.

The ambition is substantial. Each neighbourhood health service will bring together GPs, community nurses, hospital doctors, social care workers, pharmacists, dentists, optometrists, paramedics, social prescribers, local government organisations and the voluntary sector into integrated neighbourhood teams serving populations of 30,000-50,000 people. New voluntary contracts from 2026 will enable single neighbourhood providers and multi-neighbourhood providers covering populations up to 250,000. The vision is care that is joined up, community-based, and proactive rather than reactive.

This is the right direction. Nobody seriously disputes that. But neighbourhood health makes a structural demand that the policy framework has not addressed: it requires the LA-NHS boundary to work. Not in the future. Not once the Data (Use and Access) Act is commenced. Not when local government reorganisation is complete. Now. Every day. At every crossing. For every patient whose care involves both a clinical and a social care component — which, in the populations neighbourhood health is designed for, is nearly all of them.

NHS Neighbourhood Health Policy: The Boundary Is Absent

Read the Neighbourhood Health Guidelines 2025/26. Read the 10 Year Health Plan itself. Read the NHS Confederation’s analysis of what the contractual mechanisms require. The language of integration is everywhere: “joined-up care,” “working across organisational boundaries,” “partnership working,” “collaborative culture.” The guidelines ask ICBs and local authorities to “connect as broadly as possible” and to develop “joint demand and capacity assessment, modelling and planning across health and social care.”

What you will not find is any sustained engagement with the structural reality that this series has documented: that the organisations being asked to integrate operate under different constitutional authorities, different legislation, different funding regimes, different data architectures, different accountability mechanisms, and different professional frameworks. The boundary between them is not an administrative inconvenience to be overcome by goodwill and co-location. It is a constitutional feature of how English public services are organised.

The Nuffield Trust’s assessment of integrated neighbourhood teams, drawing on a decade of integration attempts, is direct: many attempts at different types of integrated care have had disappointing results. The challenge of engaging general practitioners should not be underestimated. Integration is not cost-free in terms of time. And — citing Walter Leutz’s foundational work on integration — overdoing integration can simply recreate barriers and fragmentation within the organisation.

Matthew Taylor, chief executive of the NHS Confederation, wrote in October 2025 that the neighbourhood health service “risks becoming a conceptual muddle.” He observed that many healthcare leaders note “multiple decades of integration rhetoric without meaningful change.” The government needs to set out a much more compelling vision, he argued, because “the shift to a neighbourhood health service must be presented as the right solution, and not simply a mechanism to bolster out-of-hospital activity.”

This article argues that the missing element is not vision. It is infrastructure.

Co-Location vs Integration: Why Shared Buildings Don’t Govern Crossings

The Manchester Local Care Organisation describes its integrated neighbourhood teams as follows: community health care teams and social care teams “based together” in what they call INTs. Being co-located, they explain, means care can be “planned and delivered in a seamless way.” Each team has a leadership team made up of a neighbourhood lead, social care lead, nurse lead, health development coordinator and GP lead. The teams also work with council neighbourhood teams, housing associations, police, mental health services and voluntary organisations.

Manchester’s model is one of the most developed in England, and the description reveals both the achievement and the gap. Teams are “based together” — they share physical space. They have a joint leadership structure. They work with partners. But the community health care teams are employed by an NHS trust. The social care teams are employed by the local authority. Their data sits in different systems. Their professional accountability runs through different regulatory bodies. Their funding flows from different sources. When a patient’s needs cross from health to social care, the crossing described in this series still happens — it simply happens within the same building rather than across different postcodes.

Co-location solves the relationship problem. People who sit in the same room know each other. They can have a conversation. They understand each other’s constraints. This matters enormously, and every piece of evidence on integration confirms it. But relationships are not governance. When the staff rotate, when the social care lead moves to another team, when the GP lead retires, when the local authority reorganises — the relationships leave with the people. The second article in this series documented this pattern: every previous reorganisation stripped away the informal workarounds that made the boundary tolerable, because those workarounds were carried by people, not infrastructure.

The NHS Confederation’s contractual analysis of neighbourhood health is explicit about this risk: governance arrangements must “actively prevent the NHS voice from overshadowing others,” ensuring “equity across partners, particularly the VCSE sector and local government.” There is a risk of scepticism, they note, with “many healthcare leaders noting multiple decades of integration rhetoric without meaningful change.” The proposed solution is “flexible frameworks and incentives that promote collaboration.” This is necessary. It is not sufficient.

What INTs Demand of the LA–NHS Boundary: Seven Flows Applied

Consider what happens when a neighbourhood health team takes on responsibility for a patient with multiple long-term conditions — the priority cohort identified in the October 2025 medium-term planning guidance: people with moderate to severe frailty, people living in a care home, people who are housebound, people at the end of life.

This patient’s care will involve a GP managing their clinical conditions, a community nurse providing clinical care at home, a social care worker arranging personal care, a pharmacist reviewing their medications, a voluntary sector befriender addressing isolation, and potentially a hospital consultant providing specialist input remotely into the neighbourhood team. That is a minimum of six professionals, employed by at least four different organisations, funded by at least three different budget lines, operating under at least two different legislative frameworks.

For this patient, the LA-NHS boundary is not crossed once — as in a hospital discharge — but continuously. Every week. Every interaction. Every decision about whether a need is clinical or social, whether a service is health-funded or means-tested, whether a safeguarding concern sits with the NHS or the local authority. The boundary is not a line this patient crosses; it is the medium they live in.

Now apply the Seven Flows:

Identity. Is this patient known to all six professionals by the same identifier? The GP uses the NHS number. The social care worker uses the local authority client ID. The voluntary sector befriender may not have access to either. The fourth article showed that no shared identifier is mandated across the boundary.

Consent. Has this patient consented to their clinical information being shared with the social care worker? To their social care assessment being visible to the GP? To the voluntary sector befriender seeing any of their records? Each sharing crosses a constitutional boundary with different lawful bases. “Implied consent for direct care” covers clinicians within the NHS. It does not automatically extend to local authority employees or voluntary sector workers operating under different legislative authority.

Provenance. When the community nurse records a clinical observation, and the social care worker records a functional assessment of the same visit, those two records exist in different systems, created under different authority, for different purposes. When the GP reviews the patient’s situation in a multidisciplinary team meeting, which record carries which weight? What is clinical evidence and what is social care assessment? The provenance of each data element matters because it determines what can lawfully be done with it.

Clinical Intent. The neighbourhood team’s care plan for this patient will combine clinical goals (blood pressure control, medication optimisation, wound care) with social care goals (maintaining independence, supporting carers, preventing isolation). These goals may conflict: a clinical recommendation for residential care may encounter a social care assessment that prioritises remaining at home. Who holds the governance for the integrated care plan? Under whose authority was it created? If the patient deteriorates, whose clinical intent governs the response?

Alert and Responsibility. If the community nurse identifies a safeguarding concern during a home visit, the responsibility transfer is governed by law: the local authority is the lead agency for adult safeguarding under the Care Act. But the concern was identified by an NHS employee during NHS-funded care. The alert must cross the constitutional boundary. Who is responsible during the gap between identification and acceptance? The neighbourhood health guidelines say that “service boundaries should not prevent seamless, joined-up care.” The constitutional boundary exists regardless.

Service Routing. When this patient needs a new service — specialist input, an equipment adaptation, a respite placement — the routing decision crosses the boundary. A clinical need routes through NHS commissioning. A social care need routes through the local authority. A need that is both — as most needs of this cohort are — requires a routing decision that spans two commissioning frameworks. The NHS Confederation notes that the integrator function will manage “ICB-commissioned contracts and pooled budgets — often through Section 75 arrangements — with local authorities and other partners.” Section 75 agreements are the mechanism this series has repeatedly shown to be fragile, organisation-specific, and unable to survive reorganisation.

Outcome. Does the neighbourhood team know whether its integrated care plan is working? This requires outcome data from both sides of the boundary: clinical outcomes from NHS systems, social care outcomes from local authority systems, patient-reported outcomes from wherever they are collected. The fourth article showed that no data flows from social care to the NHS. The outcome loop cannot close across the boundary because the data infrastructure does not support it.

43 NHS Neighbourhood Health Pilot Sites: One Structural Gap

The 43 wave 1 sites vary greatly in size and approach. Some, like the south-east London sites, involve formal partnerships between NHS trusts, local authorities, and primary care alliances. Others are more loosely convened. The King’s Fund observes that test sites will not receive additional funding but will be supported through coaching, expert guidance, and collaborative learning.

Four enabler groups have been established — focusing on data/digital, finance, estates, and workforce — to examine common barriers to implementation. This is welcome. But none of these enabler groups addresses the governance infrastructure at the boundary itself. Data/digital will grapple with the chasm described in the fourth article. Finance will confront the different funding regimes. Estates will address physical co-location. Workforce will tackle the professional boundary questions. Each addresses one facet of the boundary problem. None addresses the boundary as a systemic governance challenge.

The PPL analysis of the neighbourhood health guidelines identified the gap clearly: “The need for some form of integrator function to enable neighbourhood delivery and co-ordinate the different activities and services is not considered, and local systems will need to think about what mechanisms they require to make this work.” The question is not whether this function is needed. It is what infrastructure underpins it.

And these 43 sites face an additional challenge that this series has documented: the boundary they are trying to work across is itself being reorganised. Local government reorganisation will dissolve and re-form the local authority partner. ICB mergers will restructure the NHS commissioning partner. The second article showed that neighbourhood health pilot sites are selected on geographies that may not exist in their current form by the time the programme scales. A neighbourhood health team that builds its integration around a specific local authority social care team, within a specific ICB commissioning arrangement, under a specific Section 75 agreement, is building on foundations that are simultaneously being excavated.

Boundary Governance Infrastructure for Integrated Neighbourhood Teams

Neighbourhood health does not need less ambition. It needs infrastructure that makes the ambition deliverable.

The Seven Flows framework defines what governed integration requires at every boundary crossing. For neighbourhood health specifically, the infrastructure requirements are:

A shared identity layer across all partner organisations, so that every professional in the neighbourhood team can identify the patient consistently. This exists — the NHS number can serve this function — but it is not mandated across the boundary.

A governed consent framework that makes the constitutional crossing explicit and manages preferences across domains. Not a single consent form, but infrastructure that ensures every data sharing within the neighbourhood team satisfies the lawful basis requirements of both constitutional domains.

Provenance tracking on every record, so that clinical data and social care data can be combined in a multidisciplinary team meeting without losing the constitutional authority under which each element was created.

An integrated care plan with constitutional binding, so that when clinical and social care goals are combined, the governance framework for each component is explicit and the accountability for each element is traceable.

Explicit responsibility transfer protocols for every type of concern that crosses the boundary — safeguarding, clinical escalation, service failure — so that no gap exists between one domain’s duty ending and another’s beginning.

Governed routing infrastructure that connects neighbourhood teams to services on both sides of the boundary through infrastructure rather than through personal contacts and phone calls.

Outcome infrastructure that closes the loop across the boundary, so that the neighbourhood team can measure whether integrated care is producing better results than fragmented care.

This is not a theoretical framework. At Inference Clinical, the Seven Flows audit methodology assesses each of these conditions at real organisational boundaries. For neighbourhood health sites, the audit produces a structured gap analysis showing where the boundary governance infrastructure exists, where it is absent, and what is required to close each gap. The methodology works regardless of how far the integration has progressed — from early co-location to fully integrated teams — because the constitutional boundary exists at every stage.

The 43 wave 1 sites are the right place to build this infrastructure. They have the political commitment, the clinical leadership, and the local relationships to test what governed integration actually requires. The NHS Confederation’s warning about decades of integration rhetoric without meaningful change is well-founded. The difference between rhetoric and reality is not more goodwill. It is governed infrastructure at every crossing.

A Boundary Risk Assessment provides the structured starting point — mapping where each governance flow operates, where it fails, and what infrastructure would close the gap. For neighbourhood health sites, the Boundary Risk Score quantifies the governance maturity at each crossing type, giving leadership teams a measurable baseline before operational launch.

See the infrastructure solution: Neighbourhood Health Governance Infrastructure — how FHIR Cube, Hazards Engine, and SteadyTrace make the Seven Flows operational across PCNs, community trusts, and social care.

Julian Bradder

Founder & CEO, Inference Clinical

Building infrastructure for inter-organisation responsibility transfer in healthcare. 30 years’ experience in digital transformation across government, FTSE 100, and healthcare.