Neighbourhood working requires the system to fully utilise and support the care coordination role it has already introduced, writes Tom Lawrence, Director of the Person Centred Academy.
The NHS has a familiar pattern when new models emerge. Roles are reshaped, renamed and redistributed as systems adapt. Sometimes that brings genuine innovation. But sometimes it means that roles, which are only just beginning to mature, are reset before they have had the chance to demonstrate their value.
As neighbourhood working becomes the next organising principle for health and care, there is a risk that care coordination could fall into that pattern; not through deliberate removal, but through gradual dilution.
Parallel examples
This is not without precedent. In general practice, the ratio of GPs to other clinicians has fallen from 1:1.1 in 2015 to around 1:2.6 today, reflecting how far England has taken skill-mix changes relative to most comparable countries.
The physician associate role illustrates what can happen when boundaries are unclear: introduced to support staffing, the role expanded beyond its intended scope in many settings, leading to a government review, a rename, and clearer restrictions on practice. Social prescribing link workers offer a closer parallel. A defined role with a national framework, yet considerable local variation in how it has been understood and deployed. That is the kind of drift I am concerned about.
The ambition behind neighbourhood working is the right one. The government’s Neighbourhood Health Framework sets out a clear direction of travel – more joined-up, proactive care for people with complex needs, moving upstream and working across organisational boundaries.
But these ambitions depend on something fundamental – someone holding the coordination. While the framework acknowledges that delivery will require 'existing staff working differently', it offers limited clarity on which roles will be responsible for that in practice. Without that clarity, responsibility risks becoming implicit rather than explicit and therefore inconsistent.
A central role
Care coordination itself is not new. Over recent years, it has begun to take shape as a more defined and intentional function within the NHS. Through the additional roles reimbursement scheme (ARRS), care coordinators have been introduced at scale across primary care.
This represents more than workforce expansion. It is the early formation of a role with a developing competency framework and growing evidence base, supported by training standards through the Personalised Care Institute. That foundation is still maturing, but it is directly relevant to the challenges neighbourhood working is trying to address.
If anything, the move towards neighbourhood teams increases the need for coordination rather than reducing it. Bringing together primary care, community services, local authorities and the voluntary sector creates the conditions for more holistic care, but it also introduces greater complexity.
More professionals are involved and more interfaces need to be navigated. In that context, coordination is not a background function, it becomes central. Care coordinators are one of the few roles designed to hold that overview, support shared care planning, and maintain continuity for people moving between services.
The challenge is unlikely to present as a clear decision to remove care coordinators. It is more likely to happen quietly. As neighbourhood teams form, roles may be reframed under broader titles or absorbed into wider 'integrated' functions. Language shifts, job descriptions blur, and over time the distinct identity of care coordination becomes less defined.
While often well intentioned, this can lead to misalignment with existing training and competency frameworks, reduced clarity about accountability, and a gradual erosion of the role’s purpose. When coordination is not clearly owned, it tends to default to those with the least capacity to carry it, or it becomes fragmented across the system.
From policy to practice
The nursing associate role offers an illustration. While this is a clinical role with different stakes, the pattern it reveals about how workforce policy translates into practice is instructive. Introduced in 2015 with a defined scope, research has since found considerable variation in how the role has been deployed.
With some nursing associates restricted to tasks below their competency level, and others pressured to work beyond it. The Royal College of Nursing has raised formal concerns about nursing associates being used to substitute for registered nurses. The role has not disappeared, but its boundaries have proved difficult to hold consistently across settings.
This matters because care coordination is not simply a set of administrative tasks. It is a distinct skillset that sits at the intersection of relationship-based practice, system navigation, and proactive care planning. Done well, it enables more consistent patient experience and better use of clinical time. Done poorly, or left undefined, it leads to duplication, delay, and avoidable complexity for both patients and professionals. In a model built on integration, the absence of clear coordination is not a minor gap; it is a structural weakness.
The opportunity for neighbourhood working, therefore, is not to reinvent coordination but to embed it with intent. That means building from the existing ARRS care coordinator role, rather than relabelling it. Positioning coordinators at the centre of multidisciplinary team working with clear responsibility for care planning, and investing in their skills, confidence and reflective practice alongside expansion. It also means maintaining alignment with established competency frameworks, so that the role can continue to mature consistently across systems rather than fragmenting into multiple local interpretations.
Neighbourhood working does not require a new role to coordinate care. It requires the system to fully utilise and support the one it has already introduced. Care coordinators have the competencies, positioning and infrastructure to play a central role in this model. What they need now is not reinvention, but continuity, clarity and investment. Because in a system that is becoming more integrated, coordination is not an optional function. It is core infrastructure.
Tom Lawrence is director of the Person Centred Academy and former director of the Personalised Care Centre at Birmingham City University.