Leading Differently in Neighbourhoods – The shift from top‑down offers to locally designed solutions shows the real power of neighbourhoods

Interview with Bex Bromley, Deputy Clinical Director, Swadlincote Primary Care Network and Deputy Clinical Lead South Derbyshire Neighbourhood

Bex Bromley’s career began in nursing, working for many years in general practice before stepping into leadership roles that span across Derbyshire’s health and care system.

Today she balances clinical work at Newhall Surgery with deputy clinical leadership for her Primary Care Network and Neighbourhood Alliance.

This mix of hands‑on patient care and system‑wide leadership gives her a unique vantage point: she is both rooted in local communities and connected to the wider structures that shape health and care. Her journey from practice nurse to strategic leader reflects not only her own growth but also the growing recognition that nurses and allied health professionals can play a vital role in leading transformation.

Key aims in neighbourhood working 

In my neighbourhood role, I’m focused on connecting people and organisations that don’t always naturally come together. Being deputy clinical lead gives me access to lots of different groups, and I use that to help practices understand why neighbourhood working matters. It’s about being a familiar face, building trust, and moving from endless discussion into real action. My nursing background makes me a bit of an unusual clinical lead, but it also gives me skills that help me bring people together and develop the neighbourhood in a way that feels grounded and practical.

My style of leadership

I’ve always led in a transformational way. I believe people should be encouraged to grow on their own journeys, and that leadership should be democratic rather than authoritarian. In neighbourhoods, you can’t just tell people what to do — they’re not mandated, so they need to feel part of something bigger. My role is about making people feel valued, creating energy, and helping them want to show up. To do that, I try to be dynamic and positive, especially at a time when the NHS is under pressure and budgets are tight. The only way forward is across boundaries, with health, councils, social care, and the voluntary sector all working together.

The impact I’m most proud of

What makes me proud is seeing people turn up to our neighbourhood meetings, really engaged and excited about improving health together. A year ago, that wasn’t happening. Now, we’ve got the right people around the table, sharing resources, shaping services based on what patients actually want, and valuing professional relationships. That shift — from top‑down offers to locally designed solutions — shows the real power of neighbourhoods.

Data has played a huge role in this change. We’re now using information more intelligently, with the council helping to bring datasets together and present them in ways that make sense locally. The Federated Data Platform (FDP) is starting to give us a clearer, shared picture of population needs across organisations. It means we can see where inequalities exist, justify why some areas need more support, and design services that respond to real demand rather than assumptions.

How this differs from the old way of leading

The old way was siloed, top‑down, and focused on statistics rather than people. Organisations worked to their own agendas, and duplication was everywhere. Now, we’re listening to what local populations need, recognising differences between areas, and reducing the frustration of people having to repeat their stories. It’s a more human, joined‑up approach, and it makes collaboration feel worthwhile.

How my thinking changed at system level

Working across the system taught me to see the challenges other organisations face. Without that understanding, it’s hard to get people to engage. I’ve realised how important it is to join up workstreams and stop duplicating effort. We need to move away from reactive, acute “sticky plaster” solutions and focus on proactive, preventative change. That means knowing what services exist across health and social care and finding ways to connect them.

My catalysts and motivators

I’m naturally optimistic about improving health locally. Having worked in general practice for 14 years, I know the community well, and I love supporting people to come together. That’s what neighbourhoods are all about — collaboration, relationships, and making a difference close to home.

Opportunities and challenges

Neighbourhood working isn’t easy, but even small wins make it worthwhile. The opportunities lie in making workstreams more efficient, understanding each other’s roles, and improving population health. The challenges are around finance, governance, and contracts — someone has to hold responsibility, and that requires an organisational mindset without bias. I’m proud of the relationships we’ve built with partners like Derbyshire Community Health Service (DCHS) our community provider in Derby and Derbyshire, which show how far we’ve come. Just as importantly, I see the voluntary sector as the backbone of our system: they keep the wheels turning despite financial pressures, and raising up their role is essential if we want neighbourhoods to thrive.

Another crucial factor is estates and co‑location. When organisations share space, it breaks down barriers, builds trust, and makes collaboration more natural. Some PCNs already have this, and it shows how powerful co‑location can be in reducing duplication and strengthening relationships. Having people physically together makes “neighbourhood” feel real, not just theoretical.

How my job has changed

My role has changed enormously. I started as a practice nurse and now I’m working strategically across organisations. I never imagined myself in this kind of position, but I’m proud of the journey. For nurses and allied health professionals, leadership roles in primary care are still rare, and I’d love to see more of us stepping into them. We are trained to lead, and we bring a valuable perspective.

The impact for patients and people

For local people, the difference is that we now have a clearer vision of what our population needs, and we’re pulling together across organisations to meet those needs. We’re using data more effectively, with the council helping to present it in ways that make sense. That allows us to tailor services, recognising that some areas need more support than others.

Final reflections 

If there’s one thing I’d say to others, it’s to embrace change rather than resist it. Be prepared to work together, because that’s the only way we’ll make a real difference.