Levels of planning and commissioning: Systems, Places and Neighbourhoods

Much of the activity to integrate care, improve population health and tackle inequalities will be driven by commissioners and providers collaborating over smaller geographies within ICSs (often referred to as ‘places’) and through teams delivering services working together on even smaller footprints (usually referred to as ‘neighbourhoods’). Read more here.

This three-tiered model of neighbourhoods, places and systems is an over-simplification of the diverse set of arrangements seen in reality, but the terminology is now in widespread use within the health and care system. National policy and guidance has made it clear that ICSs will be expected to work through these smaller geographies within their footprints.

• Neighbourhoods (covering populations of around 30,000 to 50,000 people*): where groups of GP practices work with NHS community services, social care and other providers to deliver more co-ordinated and proactive care, including through the formation of primary care networks (PCNs) and multi-agency neighbourhood teams.
• Places (covering populations of around 250,000 to 500,000 people*): where partnerships of health and care organisations in a town or district – including local government, NHS providers, VCSE organisations, social care providers and others – come together to join up the planning and delivery of services, redesign care pathways, engage with local communities and address health inequalities and the social and economic determinants of health. In many (but not all) cases, place footprints are based on local authority boundaries.
• Systems (covering populations of around 500,000 to 3 million people*): where health and care partners come together at scale to set overall system strategy, manage resources and performance, plan specialist services, and drive strategic improvements in areas such as workforce planning, digital infrastructure and estates.

There is no simple answer for which activities should sit at which level due to wide variation in the scale and characteristics of local areas. As a consequence, the exact division of roles and responsibilities between ICSs and their constituent places and neighbourhoods has not been laid out in legislation or guidance.

Learn more

Find out more about key organisations and teams within the NHS:

• Integrated Care Systems (ICSs)
• Integrated Care Boards (ICBs)
• Integrated Care Partnerships (ICPs)
• Specialised commissioning
• National clinical leadership
• The Getting It Right First Time programme (GIRFT)
• The Care Quality Commission
• Healthwatch
• The National Institute for Health and Care Excellence (NICE)