Purpose The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in Sydney, Australia to implement integrated care (IC) “at scale and pace” in the messy, real-world context of a District Health Service. Design/methodology/approach The paper outlines the theoretical and practical considerations used to design and develop a localised IC Strategy informed by the “House of Care” model (NHS England, 2016). Findings The need for cross-agency partnership, a shared narrative, joint leadership and an IC Strategy underpinned by proven theoretical models model is described. Originality/value This paper highlights key factors relating to implementation and evaluation of a local IC Strategy in the real world.