4. Scale what works through clear leadership and shared learning

As neighbourhood working continues to develop, a growing body of practical learning is emerging about what drives impact locally. Scaling what works is not simply about replicating a single model. It is about applying the core principles that will enable this shift – strong local teams, consistent communication channels, shared data infrastructure, and meaningful partnerships with communities and the VCSE sector.

To spread effective neighbourhood practice at scale, systems need the conditions that allow good ideas to travel: creating structures to share best practice, ensuring evaluation is proportionate and actionable, and designing forward-thinking governance that enables local flexibility rather than constraining it.

By focusing on these enabling conditions, systems can move from pockets of innovation to a consistent, high-quality neighbourhood health service that delivers proactive, connected and personalised care for all communities.

Across the cohorts in our community of practice, there was a view that neighbourhood health is scaling effectively where there is a clear, shared purpose that translates national ambition into practical local priorities.

For example, neighbourhoods that have explicitly defined a focused set of outcomes – such as improving proactive care for people with multiple long‑term conditions or reducing non‑elective admissions for frail older adults – have been able to align primary care, community services, local authority teams and VCSE partners around a common agenda.

Scaling is also working well where systems have invested in a culture of distributed leadership and learning, creating the conditions for effective practice to spread beyond isolated pilots. In some areas, neighbourhood leads, primary care network clinical directors and VCSE partners are empowered to test and adapt approaches – such as integrated care coordination meetings or community-led prevention initiatives – and then share learning through learning collaboratives across the system.

Finally, progress at scale has been strongest where core enablers are put in place at both neighbourhood and system level, reducing friction and enabling local autonomy. Practical examples include streamlined governance arrangements that allow neighbourhood teams to make decisions without repeated escalation, shared data platforms that give MDTs access to population health insights, and investment in community and VCSE infrastructure as equal partners in delivery.

Develop a clear and shared purpose, including:

• locally grounded priorities aligned to wider system goals that effectively capture intended outcomes, value proposition and collective priorities for neighbourhood working
• a unifying anchor for decision making, resource allocation and evaluation – including tangible goals and behaviour so that neighbourhood teams understand what success looks like in practice.

Establish a culture of distributed leadership, including:

• empowering leaders at every level – from community connectors to GPs, social prescribers, housing leads and VCSE partners – to identify priorities and shape solutions
• create psychologically safe spaces where teams can share challenges, raise issues early and openly without fear of blame
• leadership behaviours that enable local autonomy and emerging practice rather than centralised command and control.