What kind of relationships did Big Local resident-led groups have with health organisations?

In the Big Local programme, residents allocated funding based on what their community needed. All Big Local partnerships decided to carry out activities that would address the physical and mental health and wellbeing of their populations. They improved recreation spaces, provided food in a cost-of-living crisis, supported exercise classes, and worked to tackle social isolation. 

This sort of preventative work could, and did, take place without the involvement of health agencies or health commissioners. The involvement of health partners was never a requirement of Big Local partnerships and was not essential to achieve positive outcomes. 

However, there was a good case for partnerships to engage with health services. Where Big Local partnerships aimed to improve health outcomes in their community, partnering with local health services could help them reach more residents and even help influence the nature of mainstream health delivery. But it was also very challenging.

Local Trust has explored the work that residents in Big Local areas did to address the wider determinants of health and the ways in which being involved in Big Local could benefit health in other articles.

In early 2021, partnerships in 42 of the 150 Big Local areas had relationships with health agencies (Baker et al., 2022). This figure is likely to have increased as the programme progressed.

Across the Big Local programme, partnerships may have navigated the following health institutions to drive collaborative working.

• GP surgeries and medical centres. Perhaps the most well-known face of NHS provision, and a core part of primary care, alongside dentists and others. From 2019, Social Prescribing Link Workers (who refer people into non-medical wellbeing support) were often based at GP surgeries (NASP, 2024).
• Public health teams, based in local authorities. These were responsible for a lot of preventative work, such as support to stop smoking.
• Clinical Commissioning Groups (CCGs), which were created in 2012 (NHS Confederation, 2021).
• Integrated Care Systems (ICSs). These replaced CCGs in 2022 and were developed as partnerships to bring together local health and care organisations to develop plans and services. ICSs have faced challenges in including the voluntary and community sector, whose influence over decisions has been limited (Hashmi et al., 2023; Charles, 2022). 
• Third sector partners commissioned by local and health authorities to provide core health services.

This is not an exhaustive list but gives an idea of the range of organisations Big Local partnerships may have faced and how the system was ever-changing. 

When Big Local partnerships chose to engage with health organisations, they took on different roles.

Partnerships and workers often worked to support existing healthcare practice, without necessarily seeking to change that practice or influence its design. For example, linking Big Local wellbeing activities (like walking groups or Men’s Sheds) with health partners (Munro and Dayson, 2025). These initiatives often received referrals from local services as a result. In addition, Big Local community hubs provided office space to healthcare practitioners, and partnerships promoted things like warm hubs in GP surgeries to reach more people. 

These examples helped partnerships to build relationships with health services and reach more residents to meet their health-related needs. There were also cases where partnerships took a leadership role in working with health partners, working to make existing practice more joined-up and coordinated. 

For example, W12 worked with partners to bring in organisations (like Citizens Advice) and a foodbank into a local health and wellbeing centre. This meant people could get essential support at the same time as health treatment and advice. This happened for a period, thanks to regular stakeholder meetings which included the Big Local chair and local health stakeholders. 

In Cumbria, Ewanrigg​’s Hug a Mug mental health café was developed with the local NHS. It received around 100 referrals from local GPs and other partners, and was based in a high-footfall health centre. 

A third example was in the Tonge with the Haulgh Big Local area. Following community feedback in 2015, the partnership developed an arts-based group for women experiencing chronic health conditions. The Big Local worker at the time approached a local health centre, proposing that residents could be prescribed to join this group. The group became active and well-attended, and health practitioners referred their patients to it (Munro and Dayson, 2025).

Big Local partnerships worked with health services to improve communities’ access to mainstream services. For example, some helped services to access people and groups they may have struggled to reach previously (Local Trust, 2020). Often this was achieved through co-locating health services in a community space. In Greater Manchester, the Sale West Big Local partnership worked with local public agencies to host a nurse at the same time that the foodbank was open. This example is just one of many cases in which residents worked with the local NHS to develop more conveniently located health services that would be easier for people to access. 

The quality of mainstream health support was also improved thanks to Big Local partnerships’ expertise and input. The W12 partnership worked with the local NHS centre to provide better quality support for diabetes patients, including culturally appropriate dietary advice. On the flip side, health services could also offer insight to partnerships about local health needs that could be addressed through Big Local. 

Partnerships also signposted residents to mainstream NHS services that could help meet their health needs. One way they did this was by promoting under-used services at resident activities and events (Baker et al., 2022).

Big Local partnerships’ strategic influence over local health systems was limited. They sometimes participated in local cross-sector health and wellbeing boards, but often these were a forum for sharing learning and ideas, rather than making decisions on local health policy and services (Munro and Dayson, 2025). Participation in these forums created considerable benefits, like better coordination, improved access, and better information sharing.

There were a few powerful examples where partnerships influenced the design of local services. In one case, Wick Award worked with children’s mental health services to co-design and deliver training for non-clinical staff working with young people with anxiety. 

During Big Local, there were many calls by politicians, healthcare professionals and others to make approaches to health more preventative and neighbourhood-based (Darzi, 2024). In practice, attempts to progress this agenda were often constrained by huge challenges faced by the NHS, such as high demand on emergency services.

Despite the constraints of the context, there were opportunities that provided new ways to engage with health, like social prescribing. A universal model of social prescribing was brought into the NHS in 2019 (Munro and Dayson, 2025). In this model, a Social Prescribing Link Worker is referred patients from a health professional (usually a GP). The Link Worker has a conversation with the patient and refers them to non-medical services and activities that could help address their health and social care needs (Munro and Dayson, 2025). For example, someone experiencing social isolation may be supported to join a community choir. 

The NHS social prescribing model has been criticised for not considering the limited resources of the voluntary and community sector (discussed in more detail in challenges) (Munro and Dayson, 2025). Still, in many cases there were good outcomes. For Big Local partnerships, it was an opportunity to work with health professionals to reach more people in their area. In 2023, database searches found at least 20 areas where Big Local partnerships were involved in formal social prescribing – the actual number was likely higher (Local Trust, 2023).

An approach of building trust and understanding could help cement relationships, giving health professionals time to understand Big Local.

Big Local partnerships also sometimes tried to influence wider structures, for example work on health at regional level. In Greater Manchester, Sale West hosted a visit from the region’s mayor, Andy Burnham. Meanwhile, Ridge Hill Big Local was the topic of a video hosted on NHS Greater Manchester’s YouTube channel. These partnerships helped make the case for a more community-based approach to healthcare in the region.

The length of the Big Local programme gave partnerships time to build their understanding of complex organisations. Further, the independence of the Big Local funding meant partnerships could test projects freely and then bring them to health services for wider impact. 

Having oversight of the over £1m funding for their area also gave partnerships a strong position when attending external stakeholder meetings. Additionally, the experience that partnership members gained over time helped them develop skills of negotiation, assertiveness, and partnership working (Ozano et al., 2024; Ponsford et al., 2020). This was helpful in navigating the risk of being expected to sort out problems faced by statutory services (Munro and Dayson, 2025).

Partnerships which had well-networked members, workers, or volunteers found collaboration with public agencies easier – it led to increased knowledge of which organisations to approach about what topic, and often meant people had good relationships with representatives of these agencies. 

Another enabler was the presence of champions in health organisations, who supported the Big Local ethos and made great efforts to support the work of partnerships (Baker et al., 2016). In Tonge with the Haulgh, the arts group for women experiencing chronic health conditions could meet at the local health centre thanks to a proactive GP. This GP also wrote to patients who could benefit from the group, encouraging them to attend. This helped legitimise the activity for some patients; and the GP helped evidence the group’s impact by tracking medication use of those taking part (Munro and Dayson, 2025). 

The challenges of relying on such champions are discussed below. 

Finally, co-location helped to build strong relationships with health organisations. In many Big Local areas, health and social care services (like health visitors, social prescribing, GPs, and vaccination clinics) operated alongside Big Local activities or in spaces run by Big Local partnerships. It didn’t always work perfectly – there were examples where a co-located service didn’t approach the Big Local partnership before launching a new initiative. But it made access to health services easier for many residents; and helped develop stronger relationships between health organisations and Big Local volunteers and workers. 

Health systems and their statutory remit operated at a larger scale than that of the hyperlocal Big Local areas (Hashmi et al., 2023). Alongside this mismatch in geographical footprints, health services were characterised by a wider strategic focus and more formal ways of working (Hashmi et al., 2023). 

Complexity was a barrier to work with health services (Baker et al., 2022). In several cases, Big Local residents found it hard to understand how health services worked, which services to approach, who to contact, and how to work together (Baker et al., 2016). Gaining access to health services was difficult and required skills of persuasion, passion, and energy to develop alliances and demonstrate the value of working together (Baker et al., 2016).

Language in health systems was also a barrier. A Big Local partnership co-chair described spending years learning to speak the language of statutory sector partners and, in return, teaching them how to speak the language of the voluntary and community sector (Munro and Dayson, 2025). 

Partnerships that found it too difficult to build relationships with health services often simply decided to work with other organisations (such as local charities and other public agencies) to address health and wellbeing needs (Munro and Dyson, 2025; Baker et al., 2022). 

Link workers involved in social prescribing described the challenges of their capability to work with partnerships, due in part to not always being trained in the scale and complexity of needs (Munro and Dayson, 2025). Some partnerships were concerned about the suitability of some social prescribing referrals, and the risk of being sent more individuals than they had capacity for. There was a need for improved resources, expertise, and skills in how best to communicate and engage with people to enable safe and effective practice (Munro and Dayson, 2025). 

Power imbalances created disconnects between formal health services and community groups (Hashmi et al., 2023). In one case, a partnership felt actively excluded from conversations between health commissioners, organisations, and local authorities – the worker attributed the exclusion to professionals who perceived residents as lacking knowledge (Munro and Dayson, 2025). However, perceptions varied and depended on the strength of the relationship between the community and health services, and the capacity of both resident-led groups and health professionals. 

The power dynamics between health services and Big Local partnerships needed to be overcome by developing a shared understanding (Baker et al., 2016). It took time and commitment for partnerships to develop relationships with local health services, to learn the language used, and to gain the trust of health organisations and staff (Baker et al., 2016). 

Big Local partnerships’ progress working with health services often relied on individual champions. But if this individual moved on (for example, when a service was restructured), the partnership lost the benefit of them championing their work (Baker et al., 2022). So, while these key relationships were an opportunity to advance partnership working, the loss of that relationship proved disruptive (Baker et al., 2022).

In health, short-term service delivery often had to be prioritised over longer-term preventative or community-led initiatives. As well as the acute challenges the NHS was facing, it has traditionally been treatment-focused and clinically-led (Hashmi et al., 2023). 

Funding arrangements in health tended to be short-term compared to Big Local and focused on centralised outcomes and targets (Hashmi et al., 2023). High demand for services, restructuring, and heavy workloads also limited the capacity of health services to work with communities. Increased pressures on funding and budgets meant that some successful examples of Big Local initiatives working with health services could no longer be funded. For example, the Hug a Mug community café in Ewanrigg Big Local was closed. The partnership hoped this initiative would be a legacy in the community, but pressures on the GP surgery meant it could no longer support it (Hashmi et al., 2023), despite it being considered successful. 

Developing a more community-led, preventative approach to healthcare in the NHS is a big, complex challenge that was not the responsibility of Big Local partnerships to solve. Despite systemic barriers, effective alliances did happen. In many cases, partnerships worked with health services to increase access to Big Local activity, to benefit more residents. Many partnerships also worked with healthcare organisations to bring services to community spaces – developing a beneficial neighbourhood-based approach to healthcare. 

Influencing health strategy was more challenging and less common. Some of the barriers to working with health systems were structural; others were cultural and related to perceptions of the validity of community-led change. The pressures on the healthcare system, particularly following the Covid-19 pandemic, cannot be understated. Nevertheless, the nature of health inequalities and unmet needs in England in the 2010s and 2020s demonstrated why the community-led, preventative focus of Big Local was valuable. Access to strong social and environmental support provided in one’s community has significant positive impacts on health outcomes.