We’re now in 2026, and NHS leaders responsible for network transformation still lack clear national direction on neighbourhood working. Pioneer sites were meant to be implementing integrated neighbourhood teams, yet the policy vacuum persists. This isn’t just frustrating, it’s creating genuine operational paralysis for the people expected to make this work.
The current confusion hits three groups simultaneously. NHS providers trying to plan community-based care. PCNs attempting organisational PCN development face uncertainty about their future role. And frontline staff, the people expected to deliver multidisciplinary team working and health and care integration, are left wondering if their posts will exist in twelve months.
These aren’t abstract concerns. I’m thinking of a PCN manager who’s been building relationships with local VCFS organisations for two years, unsure if that integration work will be recognised in whatever framework eventually emerges. Or a neighbourhood team coordinator trying to sustain social prescribing partnerships whilst contracts remain short-term. These are the people doing the genuine building work of neighbourhood health whilst national policy remains aspirational.
I wrote How to Survive Austerity: A Guide for Public Sector Managers during the last period of profound NHS uncertainty. The CHERISH framework I developed then feels painfully relevant now. When national policy is unclear, two principles become critical: engage your workforce honestly about what you do and don’t know and involve them in shaping local responses rather than waiting for permission from above. Read the book
At Scale work alongside these service builders. Not the strategists in regional offices, but the operational leaders making health delivery real on the ground. We understand that implementation support means standing with people navigating messy reality, not delivering elegant PowerPoints about future possibilities. Our practical support, from managing information overload to building continuous assurance, is designed specifically for leaders under pressure.
Meanwhile, the clock ticks. The 2025-2027 window for NHS transformation delivery won’t pause for policy clarity. Local government and VCFS integration, social prescribing expansion, and implementing genuine neighbourhood working all require planning time, relationship building, and capacity building. You can’t simply switch these on when guidance finally arrives.
So, what can leaders do now? Start with some honest engagement. Tell your teams: “National direction is unclear, but here’s what we’re doing locally and why.” Involve frontline staff in designing neighbourhood models that make sense for your population rather than waiting for a perfect template. Build the relationships between health, care, and voluntary sector partners that any future model will require.
The organisations navigating this best aren’t the ones with the biggest strategies, they’re the ones with the strongest local foundations. Leadership during uncertainty means focusing on what you can control: team relationships, community connections, and practical problem-solving. It means recognising that the real experts in community-based care are often the people already doing it, not the consultants proposing it.
Policy clarity will eventually arrive. The question is whether you’ll have spent the interim frozen in planning mode or building the capabilities that any neighbourhood health model will need. The builders won’t wait. They’re too busy making it work.
At Scale support primary care leaders, NHS trusts, local government and community partners to navigate neighbourhood transformation with practical, hands-on expertise grounded in delivery reality. Get in touch to discuss how we can help.
