FOOTPRINT: Largest ICS in England, 14 locality areas spanning large urban centres (Newcastle, Sunderland) to some of England's most rural/isolated areas. Joint Forward Plan (2023-2029) themes: Longer and Healthier Lives; Fairer Outcomes for All; Better Health and Care Services; Best Start for Children and Young People.

NEW OPERATING MODEL: Three neighbourhood health sector teams - North (North Tyneside, Newcastle, Gateshead, North Cumbria, Northumberland), Central (South Tyneside, Sunderland, Durham), South (Middlesbrough, Redcar and Cleveland, Hartlepool, Stockton-on-Tees, Darlington) - 335 GP practices and 67 PCNs. Provider expected to engage with the relevant neighbourhood teams.

INCENTIVE SCHEMES: There are NO incentive schemes in place in NENC for these programmes and no plan to introduce them for Healthier You.

KEY STAKEHOLDERS: Patients, GPs, PCNs, ICB neighbourhood teams, local communities. Provider expected to engage proactively with practices/referrers, especially co-located rural practices, to create economies of scale considering local nuances such as transport.

REDUCING PRIMARY CARE BURDEN: Jointly develop or adjust referral pathways; provide digital and other access options requiring minimal GP/clinical input; enable digital referral and appropriate data-sharing; feedback data to practices, PCNs and the ICB with agreed data sets and pathways.

F2F LOCATIONS: ICB will support and facilitate but cannot direct local opportunities at depth - practices and communities have the most up-to-date local knowledge; ICB resource for this may be limited.

GEOGRAPHY: Densely populated urban areas alongside rural/coastal communities with substantial access barriers. Persistent socioeconomic deprivation driven by industrial decline, rural isolation and poorer employment/housing - higher prevalence of obesity, T2D, hypertension and multimorbidity, and lower healthy life expectancy than England average.

EVIDENCE BASE: NENC ICB Health & Healthcare Inequalities Report 2024-25 sets out system-wide intelligence on inequalities, deprivation, ethnicity and Core20PLUS5.

CORE20PLUS5 PRIORITY POPULATIONS: People in the most deprived 20% of neighbourhoods (especially Newcastle, Sunderland, South Tees, County Durham, parts of West Cumbria); people with severe mental illness; people with learning disabilities and neurodivergent individuals; ethnic minority communities where local gaps are identified; inclusion health groups (unstable housing, low health literacy, limited digital access) - use the NENC Approach to Inclusion Health.

KEY LANGUAGES: Arabic, Polish, Urdu, Bengali, Punjabi, Romanian, plus British Sign Language - validate local language requirements with partners (don't assume uniform need).

CULTURAL CONSIDERATIONS: Attitudes to weight, diet, physical activity and group interventions vary - provider must adapt delivery, materials and engagement style while remaining pragmatic at scale.

REASONABLE ADJUSTMENTS: Embedded as standard practice, not applied reactively. RURALITY: Many rural/isolated areas lack amenities and good public transport - sessions must take this into account. SIGNPOSTING: Providers must enable effective signposting and partnership working with existing local services where additional support is required.