A checklist for preparing your practice for neighbourhood working

Neighbourhood working is moving from policy language into operating reality. For practices, partners and PCN leaders, the question is no longer whether it is coming, but how prepared your organisation is when local structures start to harden.

The best starting point is not a full redesign. It is a disciplined review of the basics: footprint, relationships, governance, data, workforce, delivery credibility and local influence. This checklist is designed to help practices and PCNs work through that preparation in a structured way.

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New to neighbourhood working?

Start with our main explainer on the Neighbourhood Health Framework, population-based contracting, and what the shift means for practices, partners and PCN leaders.

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Download the self-assessment tracker

Use the workbook alongside this article to score readiness, capture actions, assign owners and track next steps across your practice or PCN leadership team.

Includes scoring sheet, summary dashboard and action tracker.

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Preview illustration of the neighbourhood working self-assessment tracker

In brief

Neighbourhood working will affect how services are organised around practices, even where the core contract itself does not change.
The immediate priority is not building a new structure overnight, but understanding how ready your practice and PCN are to work within one.
The strongest starting points are footprint, relationships, governance, data, workforce, delivery capability and local influence.
Practices and PCNs that prepare early are more likely to help shape local arrangements rather than simply react to them.

Why this checklist matters

Neighbourhood working can sound abstract until it arrives disguised as a new meeting structure, a new delivery expectation, a new reporting line, or a new conversation about who is going to lead what locally.

For practice managers, partners and PCN leaders, readiness is not really about learning a new acronym. It is about understanding whether your current practice and neighbourhood set-up is strong enough to operate in a more formal model of integrated delivery.

This checklist is designed to help with exactly that. It is not a theoretical framework. It is a practical review tool for practices that want to know where they are strong, where they are exposed, and what they should start sorting now.

1. Leadership and shared understanding

Before anything else, make sure the people leading the practice are clear on what neighbourhood working actually means locally. Many organisations lose time not because they disagree, but because each person is quietly working from a different mental model.

Checklist

Make sure partners, senior managers and PCN leaders have a shared understanding of what neighbourhood working is intended to achieve.
Separate what is already known locally from what is still speculative.
Agree the main risks and opportunities for your practice now, rather than waiting until local structures are already being proposed.
Decide who will lead neighbourhood-related planning internally.
Make this a standing agenda item at partner, board or senior management level.

2. Footprint and local position

In neighbourhood working, geography matters. If neighbourhood footprints become the basis for service delivery, planning and outcomes, your local position is not just background detail. It is part of your future operating environment.

Practices should be clear on where they sit, how that lines up with the PCN, and whether there are likely to be awkward boundary issues later.

Checklist

Confirm your current PCN footprint and how it aligns with place, locality and likely neighbourhood boundaries.
Identify any boundary complications, including split local authority links, mixed referral patterns or unusual patient flows.
Map the organisations most likely to be central to your neighbourhood model: community services, mental health, local authority, social care, pharmacy and voluntary sector partners.
Understand where neighbourhood planning conversations are currently taking place and who is in the room.
Check whether your practice is represented directly, indirectly through the PCN, or not at all.

3. Relationships and partnerships

Formal structures tend to reveal the real quality of local relationships very quickly. If neighbourhood working depends on shared delivery, then weak trust, patchy engagement or poor communication between organisations becomes more than an irritation. It becomes an operational problem.

Checklist

Review the strength of your relationships with neighbouring practices and the wider PCN.
Assess links with community nursing, mental health, social care, community pharmacy and other likely neighbourhood partners.
Identify where relationships rely too heavily on one individual rather than a stable working arrangement.
Look for gaps where your practice or PCN is not yet connected to an important local partner.
Strengthen working relationships now, before the pressure of formal delivery expectations lands on them.

4. Governance and decision-making

Neighbourhood working usually sounds collaborative until somebody has to decide something difficult. That is where governance starts mattering.

If your practice or PCN is going to operate within a more formal neighbourhood structure, you need clarity on who can decide, who can commit resource, and who is accountable when delivery goes wrong.

Checklist

Review whether your current governance arrangements are strong enough for shared neighbourhood delivery.
Clarify who has authority to commit the practice to service changes, delivery commitments or partnership arrangements.
Check whether your PCN governance is robust, current and understood by member practices.
Identify where decisions may become stuck between practice, PCN, federation, place or ICB layers.
Make sure governance documents are up to date and not quietly living off assumptions from 2 years ago.

5. Data, coding and population insight

Neighbourhood working will not run on goodwill alone. It will run on data, risk identification, coding quality and the ability to understand local population need in a practical way.

This is one of the areas where practices can quietly fall behind while thinking they are broadly fine.

Checklist

Review the quality of coding for key areas such as frailty, care plans, long-term conditions and urgent access categories.
Assess how well your practice can identify higher-risk groups within the registered population.
Check whether your clinical and operational reporting is good enough to support neighbourhood-level discussions.
Understand what shared data or record access arrangements already exist, and where the gaps are.
Make sure your practice can explain its local population needs with evidence rather than instinct alone.

6. Operational readiness

The easiest way to spot whether a practice is ready for neighbourhood working is often to ask a blunt question: if more joined-up local delivery started next month, what would break first?

Operational readiness is less glamorous than strategy, but it usually decides whether strategy survives contact with reality.

Checklist

Review how easily the practice can adapt to more shared working, joint pathways and cross-organisational coordination.
Identify processes that are still too dependent on informal workarounds or individual staff knowledge.
Check whether your practice has the project management capacity to support neighbourhood implementation work.
Review meeting load, action tracking and operational oversight arrangements.
Be honest about what your current team could absorb without something else falling off the table.

7. Workforce, rooms and practical capacity

Neighbourhood working is often discussed in strategic language, but it quickly becomes a very practical conversation about staff, skills, supervision, desks, rooms, IT access and who is actually going to manage the moving parts.

Checklist

Assess whether your current workforce model is flexible enough for more multidisciplinary neighbourhood working.
Review supervisory capacity for additional clinical or operational roles linked to neighbourhood delivery.
Check whether your premises can support visiting staff, co-location or shared working if needed.
Review IT access, onboarding and information governance arrangements for non-practice staff working alongside your team.
Identify where workforce constraints could limit your ability to participate effectively in neighbourhood models.

8. Staff and patient communication

Organisational change lands badly when staff hear about it too late or patients experience it before anyone has explained it properly. Communication is not a soft extra here. It is part of readiness.

Checklist

Plan how you will explain neighbourhood working to staff in practical, role-specific terms.
Make sure reception and admin teams understand what changes may affect patient flow, messaging or service navigation.
Think ahead about how patients will experience more joined-up local working and where confusion is most likely.
Use your PPG or other patient feedback routes to test communication messages early.
Avoid letting local change arrive as rumour first and explanation second.

9. PCN readiness: the question behind the question

For many practices, neighbourhood readiness is also a test of PCN readiness. If PCNs are likely to play a continuing role in neighbourhood delivery, or potentially evolve into something more formal, then this is the point to assess whether the current structure is actually ready for that.

Checklist

Review whether the PCN has a clear identity, credible leadership and operational grip.
Check whether member practices still see the PCN as the natural vehicle for joint delivery.
Assess whether the PCN can demonstrate delivery, not just attendance.
Identify structural weaknesses now, including fragile governance, uneven member engagement or unclear accountability.
Decide whether your current PCN is shaping neighbourhood conversations locally or mainly reacting to them.

A simple readiness test

If you want a fast sense of where your organisation stands, ask these 5 questions:

Do we understand our likely neighbourhood footprint and local position?
Do we have strong enough relationships to work beyond the practice boundary?
Can our governance and leadership handle shared delivery decisions?
Is our data good enough to support neighbourhood planning and risk identification?
Are we currently influencing the conversation locally, or waiting to hear what has been decided?

What to do next

The point of a checklist is not to create a new folder full of admirable intentions. It is to identify where action is needed while there is still time to do something useful about it.

Three sensible next steps

Run this checklist through your leadership team. Score each area red, amber or green and be honest about the weak spots.
Turn the weak spots into actions. Focus first on issues that affect influence, delivery credibility or operational risk.
Take the discussion into your PCN and local system conversations. Readiness is not just internal; it is also about whether your voice is shaping what comes next.

The Practice Connect view

The most useful way to think about neighbourhood working is not as a future structure that will eventually arrive fully formed. It is as a process that will reward organisations already capable of working beyond their own walls.

For practices and PCNs, the immediate job is not to guess every final detail. It is to get the basics strong enough that when local arrangements do become more formal, you are in a position to contribute, influence and adapt without being destabilised.

In that sense, readiness is less about predicting the future perfectly and more about making sure your current organisation is not quietly less prepared than it thinks it is.

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