Stakeholder engagement in a clustering NHS: How to keep local voices heard

The NHS is entering another period of structural change. As Integrated Care Boards (ICBs), Trusts, and Primary Care organisations face increasing financial and operational pressures, the system is moving towards clustering. This involves the merging of leadership teams, services, and resources to streamline delivery and cut costs. While clustering may improve efficiency, it poses a significant risk: local voices can be lost in the process. Stakeholder engagement, therefore, becomes more than just a communications exercise, it’s the foundation of maintaining trust, confidence, and meaningful participation from patients, staff, and community partners.

Grey Sergeant PR and Communications specialises in healthcare engagement. By working with GPs, Primary Care Networks (PCNs), ICBs, and NHS Trusts, we help ensure that stakeholder voices remain at the centre of decision-making, even as the NHS clusters.

Why stakeholder engagement matters in a clustering NHS

Stakeholder engagement isn’t optional. It’s essential for maintaining legitimacy, trust, and effectiveness in a healthcare system under change. When organisations cluster, decisions are often centralised, creating a risk that local communities feel excluded from shaping services that affect them directly.

The NHS Long Term Plan emphasises the need for stronger community-based care, digital-first services, and a shift towards prevention rather than treatment. These three shifts only succeed if patients, carers, clinicians, and local authorities are fully engaged in the conversation. Without effective stakeholder engagement, clustering could undermine the very ambitions the NHS is working towards.

Engagement ensures that:

• Communities feel represented. Local residents want reassurance that their specific needs are not lost in a wider system.

• Clinicians are involved in shaping services. Healthcare professionals bring critical frontline insights that cannot be ignored.

• Partners contribute to shared goals. Voluntary sector organisations, social care providers, and local businesses all play a role in improving health outcomes.

The challenges of engagement during clustering

The process of clustering introduces unique communication challenges.

1. Distance between leadership and communities

When boards merge, leadership teams often become more remote from the communities they serve. Patients may feel decisions are being made by people with little understanding of local realities.

2. Confusion over identity

As organisations cluster, their brand identity and messaging can blur. Staff and stakeholders may not know who to contact, who is responsible for decisions, or what the new structure means for them.

3. Risk of mistrust

Communities are already cautious about NHS reorganisations. Without clear and transparent engagement, clustering can fuel scepticism and mistrust, making it harder to implement change successfully.

How to keep local voices heard

Clustering should not silence communities. Instead, it presents an opportunity to rethink how engagement is delivered. Here are strategies that Grey Sergeant applies to keep local voices central:

1. Establish local engagement forums

Even if leadership becomes centralised, local engagement forums can ensure each community has a dedicated space to be heard. These forums should be highly visible, well-promoted, and linked directly to decision-makers.

2. Use digital platforms to widen participation

The NHS Long Term Plan encourages digital-first approaches, not only for patient care but also for communication. Online consultation platforms, surveys, and virtual town halls allow more people to participate without physical barriers.

3. Maintain a clear brand identity

When organisations cluster, communications can become fragmented. A consistent brand identity, supported by clear messaging, helps stakeholders understand who is accountable and what the organisation stands for.

4. Adopt a two-way communication model

True engagement is not about broadcasting information, it’s about listening. Feedback loops, public reporting on outcomes, and visible changes based on community input all demonstrate that voices are taken seriously.

5. Empower clinicians as advocates

GPs, nurses, and other frontline staff remain the most trusted voices in healthcare. Equipping them with clear messages and encouraging them to participate in engagement builds credibility and trust across communities.

The role of PR and communications in stakeholder engagement

PR and communications professionals play a pivotal role in making engagement effective. This isn’t simply about managing press releases or social media, it’s about shaping the narrative, building relationships, and creating platforms for genuine dialogue.

At Grey Sergeant, we help healthcare organisations by:

• Mapping stakeholders across patients, carers, clinicians, voluntary organisations, and policymakers.

• Developing communication strategies that reflect local contexts while aligning with national NHS priorities.

• Creating campaigns that explain clustering clearly, address concerns, and build confidence.

• Facilitating dialogue through community forums, workshops, and digital engagement tools.

• Measuring impact through surveys, analytics, and feedback mechanisms to show engagement is working.

Why engagement will define success in the NHS

Clustering may deliver financial efficiencies and streamline governance, but without strong stakeholder engagement, these changes risk being short-lived or resisted. The future of healthcare delivery in the UK depends on the ability of NHS organisations to balance efficiency with inclusion.

The NHS Long Term Plan is built around three shifts: moving care into the community, embracing digital-first services, and prioritising prevention. All three shifts demand strong local engagement. Communities must trust that clustering does not mean losing their voice but rather creating a system that is more responsive, efficient, and sustainable.

Conclusion

Stakeholder engagement is the key to keeping local voices heard in a clustering NHS. Without it, the risk is disengagement, mistrust, and reduced effectiveness. With it, clustering becomes an opportunity to build stronger relationships, deliver better services, and realise the ambitions of the NHS Long Term Plan.

Grey Sergeant PR and Communications specialises in healthcare engagement. We work with GPs, PCNs, ICBs, and Trusts to design communications strategies that keep stakeholders central, even in times of change. By prioritising clear, consistent, and inclusive engagement, we help organisations cluster successfully without silencing the communities they serve.

About the author

Michael O’Connor is a partner at Grey Sergeant, specialising in PR, communications, and engagement across the healthcare and non-profit sectors. Through his consultancy Grey Sergeant, he helps primary care networks, GP surgeries, and healthcare organisations define their brand, strengthen their reputation, and communicate with clarity. For more information, contact michael.oconnor@greysergeant.com