Building neighbourhood health centres without redrawing the organisational chart

The Challenge

Neighbourhood health centres are now a flagship policy direction for the NHS in England. NHS England has issued 2025/26 guidance for integrated care boards (ICBs) to progress neighbourhood health ahead of the new 10-Year Health Plan; the government has also set out the plan’s overall intent and launched a programme of centres to shift care closer to home. For mental health, 24/7 crisis access is already a national commitment, and many systems are evolving this into round-the-clock neighbourhood mental health centres so there is no wrong front door. 

This blog focusses on my area of clinical leadership: mental health in neighbourhoods, but the themes will be familiar for integration of frailty services, children and young people's services and all of the other areas of integration being proprosed. 

The strategic choice leaders face

You have two broad options:

Neither solution is perfect and both come with a number of challenges. In this blog we will explore the second option as an operating model that can be implemented without structural change. This is helpful particularly as neighbourhood health centres are tested in their pilot phases. 

An operating model that can be deployed now

Make the neighbourhood health centre a backbone, not a boss

The neighbourhood health centres provide a backbone for the services provided to the local community - for a common agenda, a shared measurement system (a single shared dashboard), mutually reinforcing activities and continuous effective communication between health, care and VCSE professionals. This taps into Collective Impact theory by aligning independent organisations and teams on health outcomes that matter, but leaves professional and corporate governance intact. 

Connect services as a network of teams

Neighbourhood health centres are envisaged to provide a range of input from primary care and community services (used to working at a neighbourhood level), as well as specialist services (traditionally embedded in place-wide institutions such as hospitals). Thinking about mental health neighbourhood centres there is a need for services provided by CMHT, early intervention teams, urgent & crisis teams, primary care and VCSE partners. Rather than dismantling these specialised services, in this model they remain under their home line management but operate as a network of teams (or team of teams) with shared purpose, shared consciousness (transparent data and communication), and empowered execution within clear 'guardrails'.

The management science here is mature - in airline operations control: the crew, engineers and ground teams all stay in the units, but operations synchronise information and decisions in real time. Each individual brings their skills around a shared purpose and works within their scope. 

Engineer swift trust to get going quickly

In aviation, pilots cannot wait months to 'gel'. In the resuscitation room, members of the trauma team can't wait hours to 'bond'. In swift trust you assume competence, make team norms explicit, and land early wins. Swift trust is a well described phenomenon in temporary and transient teams, including in safety-critical services. 

How does it work in practice?

Operational huddles

These are led at least daily by a centre manager and a clinical lead to manage flow, safety, space and handovers of care.

Shared protocols

These define who acts when. For example, crisis diversion, rapid specialist advice/consultation, social support from community and VCSE partners, GP advice and guidance. This is empowered execution: professionals forming a 'team around the person' bringing their knowledge, skills and expertise - rather the metaphorically carving the person up into chunks that fit the team. 

Single dashboards (for pilots)

These focus on collective impact through shared measurements. They could include access times, crisis/admission rates, use of shared care plans, patient reported outcomes and experience measures. Importantly, they focus on the shared impact of the network of teams, not individual teams or individual professionals. 

Networked governance

This operates broadly on two-tiers: 

Joint induction (and regular orientation)

This establishes norms, information-sharing, safeguarding, and escalation routes. If the culture within a team is "the way we do things here", then the joint induction and regular orientation seeks to establish "this is how we do things together". 

Why not just go for a single line management structure?

The 10 year plan and NHS England guidance sets out the establishment of neighbourhood centres at pace. Whilst there may be benefits of everyone being housed under one roof - and being led by one manager - there are several things to consider.

HR and legal

Such a move would likely trigger formal organisational change and/or TUPE for non-NHS trust partners. 

Operational impact

Existing services that are provided across a broad geographical area (for example, urgent and emergency care, highly specialised services) cannot be subdivided neatly to serve each neighbourhood - there may not be sufficient staff numbers for this to be practical, and importantly each neighbourhood will have different health needs. Central rotas and clinical escalation pathways still need to remain intact. 

Pilot discipline

Many of the neighbourhood health centres at this early stage will operate as pilots - and pilots need reversibility and the ability to be compared with non-pilot areas. Collapsing structures too early harms the quality of evaluation and risking disrupting established evidence-based treatment pathways. 

Engagement and culture

Staff, team, sector and professional identity and supervision are protective factors for higher quality services. Literature on collective and compassionate leadership cautions against removing them prematurely - it tends to reduce engagement and innovation!

Clinical logic: why might this improve outcomes?

Structured integrated and collaborative care between primary care and secondary care consistently outperforms usual care for depression and anxiety in RCTs and systematic reviews. In SMI, RCTs and systematic reviews show better quality of cardiometabolic care and preventative care uptake in integrated care settings. Neighbourhood health centres operationalise the principles at a neighbourhood level (care coordination, care management, outcomes-based care, specialist input, holistic care).

It is important to think of collaborative care disciplines as the operating system, not the "treatment" for individual conditions per se - so modular integrated models, run on collaborative care principles with a single set of outcomes work well. It is evidence-aligned and perfectly possible without a restructure! Remember the neighbourhood health centres are there to treat people, not diseases and disorders and we all have a responsibility towards a person's whole health and wellbeing - not just their mental health.

Management logic: Why this approach is evidence informed

Leadership without a single hierarchy

Collective/compassionate leadership improves engagement, safety culture and quality; it’s the NHS-endorsed direction for cross-boundary work. Use it deliberately in the neighbourhood health centre and the partnership board.

Examples for aviation, the military, international healthcare settings and industry are instructive: set a clear intent (your shared outcomes), publish live situational awareness (huddles and dashboards), and decentralise execution to the people closest to the problem.

Common pitfalls to avoid

A potential pitfall to have on your horizon 

The 10 year plan sets out neighbourhood health centres as the solution to the wicked problems of hospital overcrowding, health inequalities, long waiting times and many more... However, policy makers have in haste set out pilot schemes for 24/7 mental health centres, frailty, CYP and more. There is a risk here that policy makers might be creating the silos of the future - disintegrated neighbourhood teams. It is perfectly possible to be frail with a mental health condition, or young with a mental health condition. Talk to the other pilot programmes in your area and work towards avoiding the creation of new silos! 

Governance you can explain on one slide

It is possible to bring people together, to act as one, work operationally as one, without changing supervision and line management structures. This isn't about a group of disparate teams working in the same building - its about a coherent unit of people regardless of who the boss is.

This pattern mirrors NHS England’s neighbourhood health guidance and keeps you compliant while avoiding premature organisational change. 

Final thoughts

Neighbourhood health centres are a bold policy move by the government in the 10 year plan. Delivering them doesn't require you to rip up and redraw organisational charts. With the centre acting as a backbone, services operating as a network of teams, and swift trust engineered from day one, you can stand up 24/7 neighbourhood mental health centres that are integrated, measurable and that can be replicated - then decide, with evidence, whether structural change is actually required.

Author | Dr Terry Hudsen

Dr Terry Hudsen is a UK-based General Practitioner with a portfolio career that spans clinical practice, system leadership and cross-sector collaboration. 

In addition to his clinical work, Terry previously served as Chairman of NHS Sheffield Clinical Commissioning Group (CCG), leading strategic commissioning and system redesign, as well as leading the complex organisational change and transition to Integrated Care Boards. During this he led the establishment of joint commissioning arrangements between the NHS and local authorities and played a part in shaping national policy on maintaining joint health and care commissioning arrangements for local decision-making in place-based health and care systems. 

Following the dissolution of CCGs in 2022, he became lead for Population Health and System Development in South Yorkshire’s Integrated Care System, before leaving the NHS to establish an independent consultancy supporting NHS providers, local authorities and VCSE organisations with their capabilities for developing collaborative leadership, strategy and tackling wicked problems. 

In 2023, he became Independent Chair of the Bradford Safeguarding Adults Board, where he leads a statutory partnership which comprises partners from health, social care, local government, police, and the voluntary, community and social enterprise (VCSE) sector, focussing on preventing and responding to harm, neglect and exploitation of vulnerable adults. 

Alongside these roles, Terry is Clinical Lead for Primary Care and Neighbourhood Engagement and Support within NHS England’s mental health portfolio in the North East and Yorkshire, helping to drive transformation and strengthen collaboration between providers of health and care at local level. 

In addition to his medical qualifications from the University of Sheffield, Terry is a proud alumnus of The Open University Business School, where he earned an MBA with distinction in Leadership Practice. He is a Chartered Manager and a Fellow of the Chartered Management Institute. He is particularly interested in leadership across organisational boundaries, with his MBA dissertation focussing on collaboration between the NHS and VCSE sector. 

In all his roles he emphasises the power of partnership, culture and shared learning in creating sustainable change. Passionate about building a culture of curiosity and shared purpose across public services, he writes and speaks about adaptive leadership, collaboration and innovation in complex systems. His work aims to inspire leaders and practitioners to think differently, work collectively, and create meaningful impact in the communities they work. 

November 2025