UK Observatory

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UK Observatory a Sovereign Meridian view · 43 ronin · one samurai · the field, in motion

How Canvas reads a site Library About NNHIP

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What it is

NHS England's pioneer programme to test and refine the operating model for fully integrated neighbourhood health teams: primary care, community, mental health and social care working together at place-based scale (~30,000–50,000 population). Forty-three pioneer sites across England were selected to lead. The programme sits inside the Fuller Stocktake → Hewitt Review → ICB devolution arc and feeds the next NHS long-term plan.

For Place Directors, ICB transformation leads and PCN clinical directors, this is the single largest test of "out-of-hospital" care reform this decade. The pioneers don't have to invent the model alone: they do have to measure it.

Timeline (as we read it)

2024

Programme launched · 43 pioneer sites named

Site selection, baseline assessment, neighbourhood-team scope agreed across the 43 footprints.

2025

Implementation phase begins

Multidisciplinary teams stood up, integration pathways drafted, early data capture. INT model showcased (Stockton).

2026

Outcome evidence gathers · ICB-level reporting

You are here. Pioneer sites produce the first defensible outcome reports their ICBs and the centre will need. Measurement architecture is the hot question.

2027

National scale-out planning

Operating model finalised; broader rollout across all ICBs designed. Pioneer evidence shapes the national contract.

2028+

Embedded in the long-term plan

Neighbourhood health becomes the default operating layer of the NHS, with cumulative outcome reporting at the place level.

Outcomes the programme is asked to prove

Demand reduction

↓ Non-elective admissions

Fewer A&E attendances and emergency admissions in pioneer footprints: the headline ROI metric.

Self-management

↑ Patient Activation (PAM)

Higher PAM scores at neighbourhood scale: the explicit aim of integrated care; commissioned by ICBs already.

Continuity

↑ Continuity of care index

Same team across episodes; reduces duplicate work and improves clinical and patient satisfaction.

Equity

↓ Inequalities gap

Narrowing the access and outcome gap across deprivation deciles within the neighbourhood footprint.

Operating discipline

Cumulative evidence

Defensible audit trail the ICB can put in front of its board and NHS England without caveat.

Workforce

↑ Multidisciplinary fluency

Frontline teams that work across primary, community, mental and social: measurable in retention and team-survey data.

Where RiDraw fits

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Five Elements outcome architecture applied per site: turns scattered NNHIP data into a board-defensible audit trail.

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EQ-5D-5L + PAM as the universal anchor + domain depth pairing: the same instrument across all 43 sites, so ICB-level comparison becomes possible.

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Apple HealthKit + Android Health Connect capture: patient holds the data, RiDraw aggregates cohort signal only. Sovereignty by absence at Phase 1.

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A commissioned field reading per site: bound A5 outcome book + briefing call + audit register. Same artefact format as Aberdeen, applied to your neighbourhood. Commercial terms live in the internal reach-out tracker, not on this page.

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The AI Lake compares across the 43:what nobody else can do because nobody else holds all 43 in one frame.