In Southwark and across the country, the NHS is working closely with local councils, voluntary groups and community organisations to develop and deliver neighbourhood health services, in line with the ambitions set out in the national 10 Year Health Plan.

Neighbourhood working will transform how we support people’s health and wellbeing by bringing more care closer to home and making services easier to access. It will help people live healthier, more independent lives and reduce unnecessary hospital visits by providing joined-up, personalised care.

Neighbourhood working goes beyond treating illness. It reflects the 10 Year Plan’s ambition to shift the NHS from treating illness to proactive prevention and wellbeing support. This means helping people stay well at every stage of life, giving them more control over their care, and addressing the wider social factors that impact health, such as housing, employment, education, and social connections.

Neighbourhood working is not new to Southwark. We have a strong foundation of integrated local services and partnerships. This next phase builds on that work to deliver the 10 Year Health Plan’s ambitions.

Neighbourhood teams

Developing Neighbourhood Teams is essential to delivering personalised, joined up and localised care across south east London. 

Neighbourhood teams will go beyond multi-disciplinary working by fully integrating staff from health, social care and voluntary services into a single local team, responsible for delivering seamless and coordinated care in a specific neighbourhood. They will work closely together to provide joined-up, personalised support shaped by the unique needs of the communities they serve.

Our aim is to make care more connected, easier to access, and better coordinated so it responds not just to clinical needs, but to the full range of a person’s physical, mental, emotional and social needs.

What are the neighbourhoods in Southwark?

Southwark is divided into five neighbourhoods:

You can find out more about services in your neighbourhood by:

  • clicking on the map on the right, or
  • entering your postcode below.

What the neighbourhood health service will mean for you

  • Joined-up care: different health and care services work together to support all your needs.
  • Easier access: services will be available closer to home, reducing travel and waiting times.
  • Better ongoing support: you see the healthcare professionals from the same team more often, leading to better follow-up care
  • More focus on preventing ill health: support for healthy lifestyles, mental wellbeing, and long-term conditions before problems get worse.
  • Easier to work out what services you need: with teams working together, it’s easier to find the right help when you need it.
  • More personalised care: services are tailored to meet your needs

Where are we now?

Neighbourhood healthcare is not a new idea, we have been working in Southwark to join up services to better support residents for many years. Click on the titles below for examples of how we are working in neighbourhoods.

Proactive care for frailty – developing our integrated model in the Camberwell and Walworth Neighbourhood

The Camberwell and Walworth Integrated Neighbourhood Team (INT) started working in November 2024 from two GP practices in the Walworth Triangle area, to develop improved ways of identifying and supporting people who have severe, moderate or mild frailty. In the spring of 2025, work began to scale up this approach, practice by practice, across the whole of the Camberwell and Walworth Neighbourhood.

This INT brings together clinical and non-clinical staff from general practice, hospitals and the community and voluntary sector into one team, providing proactive case management and support to help them live healthier lives for longer, reduce multiple appointments, unplanned hospital admissions and the need for long term care.

Individuals identified as frail from GP lists receive a comprehensive geriatric review in their own home and further support and advice. Input from the team enables these patients to receive care closer to home, reduces demand on hospitals and improves liaison between general practice and hospital teams. Patients also benefit from revisions to their medication, and having the opportunity to think about and document their preferences for care in the event of serious illness or incapacity in the future.

Frailty is not an inevitable part of ageing. Work also continues, including outreach through community groups and housing teams, on preventive approaches to enable people to stay well, and to identify and offer appropriate support within the community to people with mild or moderate frailty so that they live independently for longer.

Frailty is a priority in Partnership Southwark’s Health and Care Plan. The Walworth Triangle, home to 42,000 people, was chosen for this project due to its high hospital admission rates and significant social and economic challenges. The area is more ethnically diverse than Southwark overall, with 58% of residents identifying as non-white. Testing this model here addresses local health inequalities and promotes person- and prevention-focused care

The Child Health Integrated Learning and Delivery System (CHILDS) model

Providing early intervention and personalised care for children and young people with more complex needs.

The Child Health Integrated Learning and Delivery System, or CHILDS model, was introduced to bring together general practitioners, paediatricians and community nurses in neighbourhood-based teams to support children and young people with asthma, eczema and constipation. Results across Southwark and Lambeth, where the system in place, have shown reductions in emergency department attendances, hospital admissions, and outpatient appointments for those seen by the service.

The CHILDS offer was expanded in 2025 to strengthen support for children with emotional wellbeing needs, particularly those who may not meet referral thresholds for specialist services. This additional support builds on the mental health input already linked to some teams and reflects the wider ambition to integrate physical and emotional health more closely.

Building on the CHILDS model, Southwark’s new Children and Young People Integrated Neighbourhood Teams will provide better coordinated, earlier, and more joined-up care. This work will help address health inequalities and support better outcomes for children and families across the borough

Your voice matters

Find opportunities to get involved in our work in neighbourhoods, across the borough, and more at Let’s Talk Health and Care

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