Neighbourhood Development Can The System Management Cope? A Final View for 2025

Neighbourhood Development Can The System Management Cope? A Final View for 2025

Our local GP practices and PCNs want to support integrated neighbourhood working and local development. Neighbourhood working will not fail because the vision is wrong. It will fail because the operating system underneath it doesn’t exist yet. We talk confidently about integration, prevention, continuity, and neighbourhood models but the operational reality inside practices and PCNs is far more fragile:

• collapsing clinical/admin/management capacity from national contract underfunding over many years.

• digital tools landing faster than teams can implement them.

• inconsistent communications from the system.

• widening governance gaps.

• data quality issues blocking meaningful insight.

• no shared operating synergies across wider health systems.

• GP and other clinical leaders’ firefighting instead of planning.

Can the system management and leadership cope? A major driver is the completely understandable but resultant shift happening across the NHS: Funding is being moved away from management roles to maximise clinical time. In the short term this makes sense. Demand is overwhelming - clinical pressure is nonstop. But across a whole NHS system, the consequences are significant:

• The UK already has below-average levels of management compared with high-performing health systems.

• Reducing operational management capacity removes the infrastructure required for neighbourhood working, digital adoption, population health management and Q.I. to function.

• The burden shifts to clinical leaders, who are already overstretched.

• The system becomes more fragile, more reactive, and less capable of delivering change safely.

Neighbourhood working cannot thrive in a system that is structurally under-managed. Funding streams will remain fragmented too. Core funding, LES allocations, DES allocations, transformation pots, prevention budgets, local authority contributions, pilots, and grants. Ambition without stability. Neighbourhood working is not struggling because people do not care or the model is wrong. It is struggling because the delivery structure beneath it has no been built or protected. Neighbourhoods need:

• governance and assurance.

• strong and effective communications.

• digital readiness.

• good data quality.

• improvement capability.

• patient experience data.

• operational capacity.

• leadership support.

These are not nice to haves. They are the operating system. As we move into 2026, we need an honest conversation: Are our ICBs and NHSE colleagues investing in the future system or simply trying to survive the week?

William Greenwood

LMC Chief Executive