North Central London Health Alliance

This case study shares key learnings on: 

• Co-production with staff.
• Setting up robust governance and structures. 
• Using existing forums to build local relationships.  

Background  

North Central London (NCL) Health Alliance is an ‘all in’ provider collaborative for the North Central London region. The alliance is comprised of all NHS trusts and foundation trusts in the system, including those providing acute, mental health, community and specialist services, and the NCL GP provider alliance, which covers all GPs in the area.  

Improving neighbourhood-level support for those with frailty and long-term conditions  

Camden is an ethnically diverse borough with a high proportion of social housing and of single person households. One in 10 people living in the borough are over the age of 65, and there are a high number of housebound elderly and frail people living in the community. In Camden, social isolation has been linked with poor quality of life, lower levels of happiness, higher prevalence of mental health issues and high levels of frailty and long-term conditions.  

To address these issues, and improve people's physical and mental health outcomes, the NCL Health Alliance has focused on delivering more joined up and holistic support for frail people and those with long-term health conditions. The ambition is to reduce unnecessary hospital admissions among these groups.  

To do this, the alliance realigned the Central and North West London NHS Foundation Trust’s community health teams from three large integrated district nursing and therapy teams made up of 143 staff in total, into five integrated neighbourhood teams (INTs). The first INT was set up in 2024 as a test and learn site in Kentish Town, in the east of the borough. The next four INTs are now being developed across the patch, based on learnings from this initial model. 

The INTs are multi-agency and multi-disciplinary groups of staff working in flexible, co-located spaces with other public sector and voluntary sector partners from their local communities. The teams are comprised of a range of staff, including social workers, community mental health workers, district nurses, community rehabilitation staff and GP partners.  

The enablers  

Working in INTs represented a significant change for frontline staff, and a consultation was run with all staff impacted. This process aligned staff with the new different INTs and created new workflows and processes to protect safety and quality of care. This has been instrumental in giving staff a say in how services are changing and bringing them along on that journey. Ultimately, this has helped to design an approach that works for patients, for the system and for staff. 

The alliance has created new structures and governance at borough-level to support the development of INTs across the patch. The Camden integrated care executive board, comprised of representatives from each organisation, sets the vision and agrees the strategy for this work.  A neighbourhood executive group, made up of directors and senior managers from the constituent organisations then develops project plans and sets goals across the borough, while a neighbourhood steering group of INT leads and frontline staff meets regularly to collect feedback to both share with the executive board and drive change management within INTs. This approach has helped to build traction and bring people together to develop a united vision and strategy.  

Building close relationships with wider system partners, including the voluntary sector and social care, through communication and a strong focus on people, has also been vital. Before launching this work, Camden had several multidisciplinary forums and close partnerships  between health, the voluntary sector and social care, which the INTs have been built from.  

Delivering benefits for staff and local people  

Although this approach is relatively new, it has already brought benefits to patients and staff in the patch. For instance, it has enabled staff from different disciplines and sectors to share skills and knowledge. There is some early evidence that, in the first INT site in Kentish Town, sickness days and attrition among staff are both falling. Staff now report feeling less isolated and better supported when dealing with complex patients. 

The INTs are helping to improve early intervention where there are signs of clinical deterioration, which the team believe will start bringing down the need for crisis care. Health and social services teams are also rolling out joined up home visits for hard-to-reach patients and are already seeing an improved standard of referrals between services. 

Next steps for the alliance 

The team is using the learnings from the neighbourhood in the east of the borough, in Kentish Town, to further develop INTs in the four other areas. The team is looking for suitable spaces for neighbourhood teams to work in. In inner London, finding suitable, large premises presents a challenge to co-location, which is viewed as a vital element in effectively delivering integrated care at a neighbourhood level.  

At a national level, the team say that funding must follow ambitions to prevent –ill-health and shift more into the community to support the alliance, and others, to scale up existing neighbourhood work.