North London Partners logo

We are a partnership of NHS, councils, and voluntary sector organisations, working together to improve health and care in Barnet, Camden, Enfield, Haringey, and Islington.  

Home E Our working areas E Population health and integrated care

Population health and integrated care

NCL’s Population Health and Integrated Care Strategy sets out how our integrated care system will approach improving the physical and mental health of local people and reducing health inequalities. It builds on the great work already happening locally to join up care and sets a future direction of care that is truly integrated around people and communities.

It describes a shared vision for the integrated care system focused on prevention, early intervention, and proactive care and starts to bring to life how partners will work together to achieve it through a shared set of priorities and outcomes.

The strategy was developed by and with partners in the local integrated care system including the NHS, local councils, public health, NHS trusts and the voluntary and community sector.


Our collective ambition for population health and integrated care

‘As an integrated care partnership of health, care and voluntary sector services, our ambition is to work with residents of all ages of North Central London so they can have the best start in life, live more years in good physical and mental health in a sustainable environment, to age within a connected and supportive community and to have a dignified death. We want to achieve this ambition for everyone.’

You can read full and short versions of the NCL Population Health and Integrated Care Strategy on our website:

Highlights from the strategy are also available to read using the drop-down boxes below.


Our principles for becoming an integrated population health system

We have identified ten principles which will guide our news ways of working, including examples of what that looks like. We will need to make substantial changes to how we work with our residents and communities, and this will involve changing how we prioritise our resources and efforts. NCL’s Population Health and Integrated Care Strategy sets out a clear call to action to our providers to reflect on how their organisations will look and feel when they align to these principles.

  1. Trust the strengths of individuals and communities

We listen to our communities and develop care models that are strengths-based and focussed on what communities need, not just what services have already delivered.

  1. Break down barriers and make brave decisions that demonstrate our collective accountability for population health

We understand each other’s viewpoints and take shared responsibility for achieving our ICS outcomes and our role as anchor institutions.

  1. Build from insights

We create digital partnerships and use integrated qualitative and quantitative data to understand need.

  1. Strengthen our Borough Partnerships

We build a system approach for local decision making and accountability to support local action on physical and mental health inequalities and wider determinants.

  1. Mobilise our system’s world class improvement and academic expertise for innovation and learning

We build the evidence base for population health improvement and innovative approaches to improve integrated working.

  1. Break new ground in system finance for population health and inequalities

We shift our investment toward prevention and proactive care models and create payment models based on outcomes.

  1. Build ‘one workforce’ to deliver sustainable, integrated health and care services

We maximise our workforce skills, efficiencies and capabilities across the system.

  1. Support hyper-local delivery to tackle health inequalities and address wider determinants

We make care more sustainable by creating local integrated teams that coordinate care around the communities

  1. Relentlessly focus on communities with the greatest needs

We embed Core20Plus5 in all our programmes with a particular focus on inclusion health to make sure no-one is left behind.

  1. Deliver more environmentally sustainable health and care services

We prioritise activity which impacts our communities’ health and environment, such as transport.

Our key delivery areas

We have agreed delivery areas where we can make the greatest impact and continue learning about joining up care and reducing health inequalities, working in local neighbourhoods across our borough partnerships and as a whole integrated system.

Deprived communities

The 20% most deprived communities in NCL.

Key Communities – Adults

Our adult NCL communities who experience greater health inequalities and poorest outcomes.

Key communities – Children and Young People

Our child and young people (CYP) NCL communities who experience greater health inequalities and poorest outcomes.

Wider determinants

Focusing on the root causes of poor health.

NCL population health risks

Our five key health risk areas where we can create the biggest impact in NCL –

childhood immunisations, heart health, cancer, lung health, and mental health and wellbeing across all ages.

Our ‘I’ statements

We have worked with communities to develop a set of ‘I’ statements that define what our new system needs to feel like for our residents, communities and service users.

A whole person

  • I am treated as a whole person and you recognise how disempowering being ill is
  • I am listened to and respected.

Feeling empowered 

  • I have the support that I need to stay healthy, both physically and mentally, and to live as independently as possible
  • I am supported by people who see me as a unique person with strengths, abilities and aspirations.

Housing and community

  • I live in a safe place with access to lots of green spaces 
  • I feel part of a community
  • I can easily access and afford local activities / services.

Patient choice and effective self-care 

  • I am involved in decisions regarding my life, my health and the support or care that I need.

Information on services, communication and navigation

  • I have the information and advice that I need, when I need it and in a form that I can understand.

Integrated care

  • I tell my story once
  • My care is coordinated across services
  • When I move between services, settings or areas, there is a clear plan and the transition feels seamless.

Our NCL Outcomes Framework

Delivery of our Strategy is supported by an NCL Outcomes Framework, which outlines an agreed set of outcomes that we as an integrated care system want to achieve for our population and a set of indicators to monitor how we are doing. For more information, please visit the NCL Outcomes Framework page by clicking here.


Local Maternity and Neonatal System (LMNS) Equity and Equality Action Plan

North Central London’s Local Maternity and Neonatal System has published its Equity and Equality Action Plan, which highlights much of the system-wide transformation work that will take place in maternity and neonatal services in NCL in the coming years. The Plan will play an important role in delivering NCL ICB’s Population Health and Integrated Care Strategy and Delivery Plan, which has Start Well as one of the key transformation programmes taking forward the ambition to deliver a population health approach and reduce inequalities.