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NHS policy may wax lyrical about collaboration, but the rules have made us territorial, writes Outsider 

“Everybody needs good neighbours…” — the lilting chorus that defined tea-time telly for an entire generation, even those who couldn’t quite tell Ramsay Street from Reading. The sentiment feels quaint now, yet strangely relevant as the NHS discovers — or rediscovers — its own fondness for Neighbourhoods. 

Yes, the ‘Neighbourhood’ is back, no longer a cul-de-sac in suburban Melbourne but a key building block in the re-engineering of local healthcare.

These mid-town size conclaves will bring together GPs, nurses, pharmacists, social prescribers, community connectors, and the occasional enthusiastic vicar, to deliver proactive, place-based care. A sort of cross between The Archers and a multidisciplinary team meeting. 

It makes sense: if integrated care systems are the landscape and ‘Places’ the boroughs, then ‘Neighbourhoods’ are where real life happens – where Mrs Jones gets her blood pressure checked, her repeat sorted, and a quiet word about that cough. They promise continuity and a touch of humanity in an often industrial NHS. 

Primary care networks were the starting point, of course, but they’ve sometimes felt like marriage counselling by email: plenty of forms, little intimacy. 

Neighbourhoods could be the next step – less contract, more connection. For community pharmacy, that’s a real chance to move from waving politely across the hedge to sitting at the same table – and maybe even sharing the biscuits. 

Of course, pharmacy has long had a different relationship with the word ‘neighbour’. In the bureaucratic world of market entry regulations, a neighbouring pharmacy isn’t a friend; it’s a potential rival.

The word crops up in applications, appeals and statutory consultations — the polite term for the shop that might steal your footfall. ‘Neighbour’ in this context means proximity to danger. 

It’s a curious irony. While wider NHS policy now waxes lyrical about neighbourhood collaboration, the regulations that govern community pharmacy still treat neighbours as contestants in a tightly refereed talent show.

For decades, we’ve been trained to eye the premises next door with suspicion: who’s applying for that new contract? Is it within 500 metres? The rules have made us territorial, not neighbourly. 

Which brings us neatly – and with faint weariness – to the latest flare-up in the local paper: the Pharmacy First row. GPs, some of them anyway, have bristled at being asked to signpost patients to community pharmacies for minor ailments.

“Sub-standard care,” a few called it, implying that asking a pharmacist to deal with a sore throat is tantamount to letting the postman do your root canal. 

Amid the usual letters, retorts, and social-media sighs it was pleasantly surprising to see the national bodies react as one  – perhaps we could do more of that?

Pharmacists pointed to years of training, clinical checks, consultation rooms, and national protocols. GPs countered with workload pressures, indemnity worries, and the unspoken fear of losing patient contact.

For the patients it must be like watching the bin men arguing over who should put the bins out, while they wonder why the rubbish isn’t being collected. 

The spat matters because it exposes the fragility of that word again: neighbour. We can talk about “integrated neighbourhood care” all we like, but the moment resources, recognition or referral patterns are on the line, the fences go up. Trust, it seems, still has to be earned. 

Still, there’s room for optimism. Every successful Pharmacy First consultation chips away at outdated perceptions.

Each time a pharmacist spots something serious and refers swiftly, or relieves the pressure on an overbooked surgery, it reinforces the idea that we’re not an adjunct but a real part of the clinical backbone of the neighbourhood. 

And neighbourhoods, at their best, are about relationships, not hierarchies. The beauty of the model is that it can humanise the system. A pharmacist who knows the local population, who shares data and priorities with GPs, who contributes to the same population-health goals — that’s someone who belongs in the room (and on the group chat). 

Perhaps we’re seeing the NHS rediscover something ancient: care delivered by people who actually know one another. The ‘Neighbourhood’ might just be the 21st-century village green. 

So yes, everybody needs good neighbours. Not just the kind who’ll water your plants, but the kind who’ll share clinical risk, respect expertise, and remember you in the next integrated care board planning cycle. Community pharmacy has every reason to step forward — not as a supplicant, but as a skilled neighbour ready to co-own the patch. 

If we can move beyond territorial instincts and old regulatory ghosts, the new neighbourhoods could be something genuinely beautiful: small enough to care, big enough to make a difference. 

And as for our friends in general practice — we might disagree about sore throats, but the invitation stands. The kettle’s on, the door’s open, and we promise not to mention the bins.

Outsider is a community pharmacy commentator