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Community pharmacies, local authorities and the VCSE (voluntary, community and social enterprise) sector should be in driving seat in designing and implementing neighbourhood services, says a new report from Reform, a Westminster think tank for public service reform.

Bottom-up leadership must take priority over NHS-dominated forums, and ‘closed-off’ NHS data systems must be opened up to other providers, including community pharmacies, it argues in its report: ‘Designing a Neighbourhood Health Service’.

The report, based on interviews with experts from the health and care sector, uses examples of best practice that should inform the government’s approach, based on granting much greater autonomy and resources to local providers.

Rather than a ‘hub and spoke’ model, centred on PCNs, Neighbourhood Health should prioritise integration of services within a neighbourhood, including public health, social care, pharmacy, and community and VCSE sector services, the report says.

Interviewees told Reform that the current approach is “too top-down” and “GP-led”, and that existing avenues for local leadership, such as Health and Wellbeing Boards are woefully under-utilised.

The think tank warns that the government must not “dictate” what Neighbourhood Health should look like in every patch, instead they should equip local areas with the capabilities they need to experiment and deliver approaches that are sensitive to local need.

The report sets out “lessons” which can be used to design a neighbourhood health service:

• Improving population health at a neighbourhood level requires those with knowledge of the area to work with communities to promote bottom-up initiatives. It is not always necessary for these leaders to be from the NHS.

• Devolving power from senior leaders to frontline workers, and encouraging collaboration with communities, can facilitate health delivery centred on individuals and neighbourhoods.

• Organisations with access to, and use of, patient data should engage in ‘outside-of-the-box’ collaborations with local service providers to develop knowledge exchanging platforms which can help providers to better understand patient profiles and risk.

• Analysis of future demand projections should be used to develop workforce strategies at a neighbourhood level. This should take into account how ARRS roles can best be deployed to provide personalised care.

• Neighbourhood Health systems should create "virtual neighbourhoods" that enable community assets to be systematically mapped and utilised to address the wider determinants of health, including to build meaningful relationships within a community and reduce social isolation.

• Local authority and healthcare providers should take stock of local assets and creatively use spaces with high footfall to manage and deliver health and care services.

“The creation of a Neighbourhood Health Service is a huge opportunity for Government to ensure a much more proactive, prevention focused health system,” said senior researcher and report co-author, Patrick King. “Neighbourhood Health must not be a continuation of the status quo – a medicalised model of primary care, stifled by overly prescriptive guidance from Whitehall.”