The NHS 10-year plan is clear: prevention must move closer to communities, and delivery must work seamlessly across organisational boundaries. Achieving this requires more than well-designed programmes – it requires genuine collaboration between commissioners, clinical teams and community providers, built on shared infrastructure, consistent ways of working and trust.
For commissioners, translating ambition into operational reality is rarely straightforward. Establishing reliable routes into support, creating effective flows between hospital and community services, and securing engagement across primary care, all demand system‑wide coordination. Prevention programmes rarely fail because of poor design; they struggle when the relationships needed to sustain them are incomplete.
Since 2023, Maximus has been working with Buckinghamshire Council and the NHS to deliver Be Healthy Bucks, a lifestyle behaviour change service supporting residents to stop smoking, reduce alcohol use and achieve a healthy weight. From the outset, the focus was on building the relationships required to secure consistent referrals, local buy‑in and sustainable delivery at scale. As a result, the service is helping people live healthier for longer, improving wellbeing and productivity while reducing avoidable pressure on acute services.
Coherent access starts with relationships, not systems
Neighbourhood‑level prevention requires clear access routes, consistent clinical standards, and shared governance. Without these, even the most carefully designed clinical pathways have nowhere to refer into. Fragmented community provision, inconsistent quality and uneven coverage can leave commissioners choosing between external providers that may bypass local infrastructure. This can also result in reliance on existing provision, perpetuating variation in access, quality and experience across neighbourhoods.
Neither option addresses the fundamental issue: the absence of strong, reliable relationships between local providers. Coherent access depends on cultivating those relationships so that community provision becomes dependable, aligned, and delivered by the most appropriate expert organisations. This reduces duplication and creates a more seamless experience for people moving through prevention and support pathways.
When the prescription‑only, nicotine‑free tablet Varenicline was reintroduced nationally in late 2024, Maximus worked with commissioners in Buckinghamshire to ensure the change strengthened local provision. A locally governed Patient Group Direction (PGD) retained investment within independent pharmacies and established consistent standards across the county. Achieving this required early engagement with pharmacy managers, technicians, prescribers and the Local Pharmaceutical Committee to align expectations from the outset.
The result was a unified PGD network of 15 pharmacies, supporting more than 1,000 referrals between August 2025 and early 2026. For residents, this meant simpler, more convenient access to timely support through trusted local pharmacies, with consistent standards of care regardless of where they live. Neighbourhood‑level access is only as strong as the relationships underpinning it, and deliberate relationship‑building produces a stable, locally controlled prevention offer the wider system can depend on.
Engagement follows the right people, not the right hierarchy
Primary care is central to prevention, but achieving consistent engagement across GP practices is complex. Participation differs by practice, meaning even well-designed programmes can achieve variable impact.
The challenge for commissioners is designing a pathway that works in principle but achieves only partial engagement in practice, not because the design is wrong, but because the execution of the engagement strategy defaults to the most obvious contacts rather than the most effective ones.
Seniority is not the same as influence. In any primary care system, the people most invested in prevention, and most able to change referral behaviour, are often practice managers, medical secretaries, or nurses rather than the GPs at the top of the organisational chart. Building relationships with these individuals ensures pathways are understood and trusted.
Working with the Integrated Care Board (ICB) and practices across Buckinghamshire, the Maximus team engaged key individuals early, attended Protected Learning Time sessions, and co‑developed referral quality feedback with Azul Strong Corcoran, Senior Manager for Prevention, Health Inequalities and Place at the Buckinghamshire ICB. Communications were adapted to maintain trust, and practices observed lifestyle groups directly, building familiarity and confidence in the offer.
For Azul, that outcome reflected a deliberate approach to how the ICB chose to work: “Our role in the ICB is to ensure that prevention is a core part of our work. In Buckinghamshire, this meant creating the conditions for services to work in a way that genuinely improves access and experience for the communities who need it most. By focusing on relationships, shared purpose and practical problem-solving, we were able to champion prevention and strengthen knowledge and pathways that reduce inequalities and make healthier choices easier for everyone.”
All 53 practices became active referrers, with primary care referrals exceeding 15,000 in 2024. Full engagement across a primary care system is rare. It does not happen through systems alone, it happens when practices have genuine confidence in the offer, and when the organisation supporting them has earned the right to ask.
Co-design is a prerequisite, not an aspiration
Strong continuity between acute and community care is essential, yet gaps often appear in hospital referral pathways. Hospitals offer an important opportunity to support prevention, but referral routes that feel burdensome or out of step with clinical workflows see low uptake. When pathways fail to reflect how teams actually work, teams don’t use them. Too often, organisations ask clinical teams to adopt pathways they had no role in shaping, and without clinician involvement, clinicians rarely refer into them. Co‑design isn’t an add‑on; it’s what makes a pathway usable and effective.
Working alongside teams across oncology, urology, palliative care, endocrine services and sexual health at Buckinghamshire Healthcare NHS Trust, Maximus co-designed a fast-track referral route built around how those teams actually work: minimal steps, immediate confirmation, and visible outcomes. Embedding it into everyday practice required sustained presence, attending departmental and Ward Manager meetings and supporting teams through implementation rather than stepping back once the route was live.
Fewer than 20 referrals in November 2024 quickly grew as teams began using the pathway. By September 2025, teams referred more than 90 people a month – clear evidence that they trusted the pathway and actively chose to use it. That growth reflected the confidence that develops when clinical teams help shape what they are asked to use, and when the supporting organisation remains present and accountable.
For the clinical teams involved, the value extended beyond referral volumes. Dr. Mark Johnson, Associate Medical Director for Population Health and Prevention at Buckinghamshire Healthcare NHS Trust, captured what that shift meant in practice: “By supporting our patients to stop smoking, reduce harmful alcohol use, and achieve a healthy weight, we are not only treating illness. We are enabling longer, healthier, and more independent lives. Embedding prevention into every patient interaction is fundamental to sustainable, high-quality care across the NHS. This partnership has shown what that looks like in practice.”
Collaboration as the mechanism, not the backdrop
Across pharmacy, primary care and hospital teams, the work in Buckinghamshire demonstrates a clear principle: shared infrastructure matters, but it is the relationships and trust built at every stage that make it work.
Dependable neighbourhood access, structured engagement in primary care, and pathways aligned with clinical workflows create coherent, trusted, and routinely used prevention services. Together, these elements form the foundation of effective care navigation, enabling people to access the right support at the right time and experience prevention as a joined‑up extension of their everyday care.
That lesson was not lost on the system leaders closest to the work. Gemma Thomas, Director of Strategy at Buckinghamshire Healthcare NHS Trust, was direct on the point: “Integration is not delivered by structures alone but is built through strong relationships. ‘Be Healthy Bucks’ commitment to building relationships across Buckinghamshire Healthcare NHS Trust is a great example of how developing relationships can improve outcomes for people.”
For commissioners, the lesson is not simply that collaboration matters. It is that collaboration and co-design must sit at the heart of service integration, creating the conditions for high quality delivery, seamless journeys for service users and better outcomes overall. This requires deliberate investment: finding the right people, designing with clinical teams rather than for them, and maintaining presence through implementation. These are not optional extras. They are the operational factors that make the difference between a prevention programme that delivers population level impact and one that struggles to do so. The results from Buckinghamshire show what becomes possible when organisations choose to make those relationships the work – delivering value for patients, the care system and the taxpayer alike.
