Back to Basics: Untangling Neighbourhood Health – Terms, Tiers & Governance

Here at THC Primary Care, we provide resources for primary care leaders, and the focus of this blog (again 😊) is the neighbourhood health agenda, but more specifically, the terminology being used.

If, like me, you would value going back to basics on who is supposed to be doing what, this blog is for you.

Throughout the blog, I also pose some questions, as each area is different.

In this piece, I cover:

• The three-tier model (System, Place, and Neighbourhood) and the organisations operating at each level

• Health and Wellbeing Boards – what they do, what they don't do, and why they matter

• The Joint Strategic Needs Assessment (JSNA) and its role in shaping local priorities

• Single Neighbourhood Providers (SNPs) and Multi-Neighbourhood Providers (MNPs) – what they mean for general practice

• Why getting governance right is essential as these changes unfold

Neighbourhood Health | The helicopter View

Feel free to download it to identify the key stakeholders in your area.

The three-tier model

The new architecture operates across three geographic tiers: System (500,000 to 3 million people), Place (250,000 to 500,000), and Neighbourhood (30,000 to 50,000). Each tier has its own set of organisations and acronyms.

 At System level, we have the Integrated Care Systems (ICSs), Integrated Care Boards (ICBs), Integrated Care Partnerships (ICPs), and the emerging Integrated Health Organisations (IHOs). The ICBs are being told to cut running costs by 50% and shift towards 'strategic commissioning', whatever that means in practice. Some are clustering, some are merging.

At Place level, we have place-based partnerships, Provider Collaboratives, and Health and Wellbeing Boards (HWBs). Place is described as 'the engine for delivery and reform'. This is where local authority boundaries typically align, and where integration between health and social care is supposed to happen.

At the neighbourhood level, we have primary care networks (PCNs), GP Federations, Integrated Neighbourhood Teams (INTs), Neighbourhood Health Centres, and the new single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) contracts, due to launch this year (2026).

Health and Wellbeing Boards

The Health and Wellbeing Board (HWB) is listed as a key organisation at the Place level. It's a statutory committee of each upper-tier local authority, established back in 2012. It brings together elected members, NHS leaders, directors of public health and adult social care.

HWBs don't commission services directly and don't hold budgets. They produce the Joint Strategic Needs Assessment (JSNA) and the Joint Local Health and Wellbeing Strategy. They sign off on Better Care Fund plans. They influence, but they are not supposed to direct.

So, where does this leave lower leaders not in the HWBs?

 If we're serious about population health, about understanding local need, about engaging with the wider determinants of health, debt advice, employment support, the things that Neighbourhood Health Centres are supposed to offer, then we need to understand where those strategic conversations happen. And for many of us, HWBs have not been overly visible. 

The JSNA is the statutory mechanism for formally assessing local population health needs. It should inform integrated neighbourhood strategies and operational plans.

Do you know when your HWB meets, or who sits on it?

For those who sit on the HWB, how does the information and decision-making filter down?

Understanding the JSNA

The Joint Strategic Needs Assessment is a statutory assessment of the current and future health and social care needs of the local population. 

It's produced jointly by the local authority and ICB, bringing together data on demographics, health outcomes, service use, and wider determinants to identify local priorities and inequalities. 

I have the opportunity to participate in some training on this, so I'll provide my feedback next month.

SNPs, MNPs, and what they mean for general practice

The new single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) contracts are designed to enable primary care to deliver at scale. The language suggests that federations and primary care collaboratives are expected to be key candidates for holding the SNP contract. 

But SNPs can also be held by acute, community, or mental health trusts. The policy says this depends on 'where local integration models prefer'. Which raises an obvious question:

who decides what the local integration model prefers, and based on what? 

I'm not sure about the multi-neighbourhood provider contracts. I believe there will be a lot of variation across the country as to what organisations hold these, and this matters enormously for the future of primary care.

Governance and Representation

In readinesss of the changes, meetings are being convened, people are jostling for position, and new roles are being created. With so many people and so little time in the calendar:

Who attends what?

What meetings are taking place?

How is information fed up and down?

What authority do you have as a representative at the meeting?

What does it truly mean to sit on some of these steering groups and boards?

This is exactly why I'm hosting a webinar with Ruth Griffiths, Partner at Hill Dickinson, on Thursday, 29th January, from 1pm to 2pm. We're calling it Directors, Representatives & Stakeholders: Getting Governance Right for Neighbourhood Working.

Ruth brings the legal and structural expertise; I bring the primary care perspective. Together, we'll work through the governance questions that sit underneath all this terminology, who holds what, who decides what, and where accountability actually lands when things go wrong.

If you're a primary care leader, a federation director, or anyone trying to work out how your organisation fits into the new architecture, this is the practical follow-up to the terminology breakdown above. I'd love you to join us.

Register here: https://bit.ly/NeighbourhoodRepresentativesWebinar

I hope this overview helps!

About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blog posts sharing insights on primary care networks.