Recognising and nurturing the microbiome: moving from ‘doing to’ to ‘doing with’

In our latest blog by Sam James (NAVCA) and Catherine Leyshon (University of Exeter), we explore why it's so important that the statutory sector works closely with communities, to improve health and wellbeing and ensure people can thrive.
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The voluntary and community sector (VCSE) plays a critical but often unseen role in shaping the health and wellbeing of communities. The smallest grassroots organisations are essential to a thriving system, despite often being unregistered and working below the radar, as our previous thought piece highlights. Amongst them are the walking groups reducing isolation, the community kitchens tackling food insecurity, the local support networks providing mental health first aid, and the youth clubs offering safe spaces. They support people who are often underserved within the health and care system, especially if their needs fall outside the scope of statutory services. These organisations also tackle the social determinants of health by working flexibly in response to demand and innovating at the local level in a way that ‘the system’ – often embodied in the major partners in Integrated Care Systems – find hard to do.  

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In light of this, how we engage with and sustain these organisations is crucial. A recent workshop run by NAVCA with the University of Exeter provided insights from those working in both the public and VCSE sector nationally and hyper locally. These insights reflect a clear tension: while participants recognise the need to nurture existing groups, support new organisations, and above all avoid damaging the microbiome, structural barriers persist. These challenges – funding constraints, local authority bureaucracy, problems with accessing bank accounts, and resource limitations – prevent the smallest groups from thriving.

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From ‘doing to’ to ‘doing with’

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This is where the #DoWith campaign comes in. NAVCA is a founding network member of the campaign that calls for a shift in how systems engage with communities: from top-down decision-making (‘doing to’) to genuine partnership (‘doing with’). Our workshop findings reinforce what many local systems still fail to recognise: the need to support and involve the voluntary sector as equal partners. Instead, many small organisations are expected to navigate complex funding models, conform to rigid commissioning processes, and participate in engagement activities not designed with their realities in mind.

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If we are serious about ‘doing with’, we must:

• Avoid damaging the microbiome by valuing the smallest organisations, listening to their needs, and ensuring they are not excluded from decision-making, whilst at the same time not overwhelming them with bureaucratic processes that exceed their capacity and don’t meet their needs.

• Nurture the existing microbiome by providing consistent advocacy, financial support, and direct engagement, ensuring they are seen as part of the system rather than as outsiders.

• Grow new organisations sustainably, but not at the expense of existing ones. Instead, connections should be fostered between emerging and established groups to strengthen the whole ecosystem.

• Remove systemic barriers that hinder local VCSE organisations, from inflexible funding models to bureaucratic hurdles in accessing resources.

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The scale of the microbiome: why it matters

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To put this into perspective, the best available research estimates show that:

• Each Integrated Care System (ICS) has an estimated 11,780 VCSE organisations.

• Each top-tier local authority has around 3,234 VCSE organisations.

• Each Primary Care Network (PCN) has approximately 404 VCSE organisations.  

These numbers reinforce the sheer scale and importance of the microbiome. The challenge is not the lack of local community-led action, but the lack of recognition and resourcing. If systems continue to undervalue these organisations, they risk disrupting the delicate balance of local support ecosystems, increasing pressure on statutory services.

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The need to recognise and support the microbiome is especially pressing as we enter a period of changes to the organisation of Integrated Care Systems and the reform of local authorities. These disruptions present both opportunity and risk to the voluntary sector. On the one hand, the voluntary sector has an opportunity to demonstrate the need for its collective strength and stability in the face of structural changes to service delivery. On the other hand, the voluntary sector risks being overlooked during the wrangling over structure and resources that will undoubtedly accompany structural reform. This is damaging to the whole VCSE sector, particularly the microbiome and the local infrastructure organisations that do so much to support the sector in their areas.  

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What needs to change?

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To truly embed the #DoWith approach, systems must move beyond tokenistic engagement and take practical steps to empower local VCSE organisations. This includes:

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• Flexible funding models that recognise the agility and impact of small organisations.

• Simplified processes that make it easier for grassroots groups to access resources.

• Co-designed engagement mechanisms that ensure small organisations are represented in decision-making spaces.

• Better use of data to identify, map, understand, and support the microbiome effectively.

• Adopting the #DoWith principles within forming unitary councils and in new devolved authorities  

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System change starts with a mindset shift. If we want to build resilient, community-driven health systems, we must prioritise collaboration over control, empowerment over exclusion, and partnership over paternalism.

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The microbiome of the VCSE sector is not just a collection of small organisations: it is the foundation of community resilience. Let’s start treating it that way.

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