Presentation from Dr Justin Woolley, Chair of the Richmond General Practice Alliance on Neighbourhood Health Services to The League of Friends, Teddington Memorial Hospital AGM, June 2026.
The NHS is once again entering a period of significant structural reform. At the Annual General Meeting of the League of Friends at Teddington Memorial Hospital on 16 June 2026, Dr Justin Woolley, Chair of the Richmond GP Alliance (RGPA), outlined the emerging vision for “Neighbourhood Working” and what it means for healthcare delivery across Richmond and Kingston.
This presentation painted a picture of a health service moving decisively away from traditional hospital-centred care towards integrated, community-based systems designed around local populations.
Introducing the Speaker and the Richmond GP Alliance
Dr Justin Woolley, a GP Partner at Parkshot Medical Practice and former Clinical Director of the Richmond Primary Care Network, chairs the Richmond GP Alliance (RGPA).
The RGPA itself was established in response to the NHS reforms introduced under the Lansley legislation and has evolved into an organisation focused on supporting local GP practices and preserving the partnership model of general practice while adapting to successive waves of NHS reform.
The National Context: From Hospitals to Communities
The direction of travel for the NHS has become increasingly clear over the past two years. The Darzi Review of 2024, the NHS 10-Year Plan published in 2025, and the subsequent Medium-Term Planning Framework all point towards a fundamental shift in how care will be delivered.
As the presentation succinctly summarised:
“Hospitals to Communities: a Neighbourhood Health Service” “Analogue to Digital” “Prevention rather than Cure”
These reforms aim not simply to improve efficiency but to fundamentally redesign healthcare delivery around prevention, integration, and population health management.
What Are Neighbourhood Health Services?
At the heart of the reforms lies the concept of the “Neighbourhood”, local populations of approximately 30,000 to 50,000 residents for whom integrated teams will take collective responsibility.
The principles underpinning neighbourhood working include:
Designing care around defined local populations;
Focusing on health outcomes rather than activity targets;
Breaking down traditional organisational silos;
Delivering more proactive and preventative care;
Managing complex patients closer to home;
Reducing avoidable hospital admissions.
Integrated Neighbourhood Teams will bring together:
General Practice;
Community Services;
Mental Health Services;
Social Care;
Voluntary and Community Sector organisations.
A key ambition is that by 2027, 95% of people with complex health needs will have an agreed, coordinated care plan.
A New NHS Architecture
The proposed framework introduces three new organisational layers:
Single Neighbourhood Providers (SNPs)
These organisations will deliver care directly to local populations of 30,000–50,000 residents and are expected to evolve largely from existing Primary Care Networks (PCNs). They will require strong local clinical leadership and genuinely integrated teams.
Multi-Neighbourhood Providers (MNPs)
Serving populations of 100,000–250,000, MNPs will coordinate services across multiple neighbourhoods, standardising delivery and sharing operational risk.
Integrated Health Organisations (IHOs)
At the largest scale, IHOs will oversee populations ranging from 250,000 to over one million people, taking responsibility for resource allocation, service planning, contracts, and outcomes across entire healthcare systems.
As Dr Woolley observed, many operational details remain unresolved:
“No money. Fast Time scales. No contracts (yet).”
Richmond’s Particular Challenges
Richmond presents a distinctive population profile that will shape local neighbourhood working priorities.
While only 4% of residents live in the most deprived areas, Richmond has an ageing population, with 16.2% of residents already aged over 65 and this figure expected to rise significantly over the coming years.
Other significant challenges include:
Dementia prevalence among older adults is expected to increase substantially.
Falls represent one of the highest rates of emergency admission among older people in London.
Obesity affects over half of the adult population.
Hospital admissions for alcohol-related conditions continue to rise.
Child and adolescent mental health indicators are among the poorest in London, particularly regarding self-harm admissions.
Building Neighbourhoods in Richmond and Kingston
Locally, partners have already begun defining future neighbourhood structures. Three broad geographical areas have been identified:
Richmond, Sheen and Barnes;
Twickenham and Whitton;
Teddington and Hampton.
A new Kingston and Richmond Place Provider Alliance has also been established, bringing together NHS organisations, local authorities, and GP federations under a shared governance framework.
Proactive Anticipatory Care: A Model for the Future
Perhaps the clearest example of neighbourhood working already in operation is the Proactive Anticipatory Care (PAC) programme, rolled out across all ten Primary Care Networks in Richmond and Kingston since 2023.
The PAC model seeks to:
Identify patients whose health or social circumstances are deteriorating;
Strengthen collaboration between healthcare providers.
Multidisciplinary teams include GPs, community nurses, social workers, care coordinators, geriatricians, pharmacists, physiotherapists, social prescribers, and mental health professionals.
Frailty: A Major Priority
Frailty emerged as one of the central priorities for neighbourhood working.
The presentation highlighted that approximately 10% of people aged over 65 experience frailty, increasing to between 25% and 50% of those aged over 85, with prevalence expected to rise substantially over coming decades.
The local frailty programme includes initiatives focused on:
Prevention and early identification;
Falls prevention;
Supporting unpaid carers;
Improved care home services;
Enhanced frailty assessment;
Hospital-at-home alternatives;
Workforce training and education;
Greater use of digital technologies.
The Beginning of Another NHS Reorganisation
Dr Woolley concluded with a pragmatic assessment:
“Start of the next re-organisation.”
Yet despite understandable concerns about funding, pace, and governance, the broad direction appears firmly established.
Healthcare delivery in Richmond and Kingston is moving towards a future where care is increasingly integrated, preventative, digitally enabled, and delivered closer to people’s homes.
The immediate priorities are clear: outpatient transformation, urgent care, frailty, and mental health.
Whether neighbourhood working ultimately delivers on its considerable promise remains to be seen. However, for patients, clinicians, and community organisations alike, the journey towards a genuinely integrated neighbourhood health service has already begun.
