What will neighbourhood health mean for patients?
William Greenwood’s PCC blog rightly says that last Year’s 10 Year Plan was “more aspirational than true planning”. That’s fine as far as it goes. But with implementation of neighbourhood health to be delivered “at pace”, including an expectation of plans to manage high priority cohorts by April 2026[1], the recipients of this localisation of integrated health and social care might like clarity about what it could mean for their care beyond the broad ambitions. They might also like to play a part in the design of their own neighbourhood healthcare.
What is neighbourhood health?
Professor David Colin-Thomé, in his article for the February 2026 edition of Insight quotes the executive summary of the 10 Year Plan:
“At its core, the neighbourhood health service will embody our new preventative principle that care should happen as locally as it can: digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, in a hospital if necessary.”
Already, there has been a considerable amount (too much?) written about what neighbourhood health is and might look like, which arguably risks obscuring rather than illuminating the basic principles. (Doubtless much more will emerge from the 43 pilots under the National Neighbourhood Implementation Programme (NNHIP), and a Model Neighbourhood Framework was promised for November 2026 by the Medium Term Planning Framework.) My sense is that the objectives tend to be conflated with the processes and tools to achieve them.
In my view, the fundamentals are to use relatively local geographical areas as the basis for achieving objectives through improved processes employing various tools. Thus
- Objectives: deliver the three shifts in the 10 Year Plan, thereby improving services for patients and efficiencies for the health and care sector
- Processes: achieve the objectives by improved integration/working together of services and service providers in a way that’s appropriate to each neighbourhood
- Tools: these include maximising digital opportunities, physical neighbourhood health centres, and measures to prevent ill-health and reduce hospital use.
I see no value debating whether, for example, this is largely a repeat of previous attempts at integration. Or whether what is called a neighbourhood is the best scale for taking this forward and whether it works in both urban and rural settings. And I’ll set aside the promotional stuff about neighbourhood health – about “creating a collaborative high-support, high-challenge culture, to develop a shared vision and outcomes”[2] or tackling “fragmentation” with a “simpler approach”[3] – however much it is hoped that the promises will be fulfilled. Fundamentally, neighbourhood health is about bringing together all parts of the health and social care sector (including the Voluntary Community Faith and Social Enterprise sector) at local level to achieve the benefits envisaged by the 10 Year Plan through locally-tailored deployment of the Plan’s three shifts.
Stripping back even further, it seems to me that the core focus of each neighbourhood should be on achieving integration. All parties should be working together to decide on the best tools to deploy to improve prevention, keep people away from hospitals and improve patient services, and then deliver together.
Processes – how to do the integration bit?
Again, the nitty gritty. This doesn’t work if all the health and care players locally are not bought in. Structures and information-sharing come into it, but at its root it’s about all the players wanting to work together and overcome barriers to doing so in order to create something better. It’s not about presenteeism: representatives of different organisations turning up to meetings just in case, rather than because they want to contribute together to the new ways of working and jointly buy in to whatever is the agreed direction of travel. So neighbourhood health needs to be founded on common ownership and harnessing relationships, not simply dropping the words “neighbourhood health” into all conversations or sitting around tables and eventually agreeing to small, single-issue initiatives to attempt to satisfy the powers that be and offer a story to tell..
As the National Neighbourhood Health Implementation Programme (NNHIP) welcome pack’s first “primary driver” puts it: “Build shared multi-organisational leadership, common purpose and common way of working, accountable to communities for what matters to them”[4]. The pack quotes Sir John Oldham, chair of the NNHIP Taskforce: “Successful implementation of neighbourhood health depends on more than policy or structure” and references relationships as a key to tackling problems.
Tools – how to choose the right tools for each neighbourhood
To achieve integration, I would argue again that the tools need to be chosen by everyone involved and affected, informed by knowledge of the existing design of services, population health data, the views of the community etc.
Beyond that, there will doubtless be plenty of discussion of the practical options for delivering the three shifts having regard to the circumstances of each neighbourhood. How to promote prevention to ensure that populations facing health inequalities are included; how to monitor and support patients at home to reduce the likelihood of hospital admission; how to operate hospital at home that works for different patients; how to structure a multi-disciplinary team (MDT) in different situations; what the role is of the new single and multi-neighbourhood providers (SNP/MNP); how to manage any impact from SNPs and MNPs on patients’ current expectations from their GP practice; how to achieve continuity of care with MDTs; and much more. And, of course, there’s the dependency on the 10 Year Plan commitment “over the course of this Plan” to shift the pattern of health spending from hospitals to out-of-hospital care.
Will integrated neighbourhood healthcare work?
Who knows? There is, and has never been, a perfect solution to providing the best, equitable health and care service possible that is also nationally affordable. Views on the best way forward will always differ and outcomes will always be mixed.
Personally I worry that this is yet another distracting reorganisation. Also that NHS administrators can be adept at taking a ‘Yes Minister’ approach: nominal compliance to avoid sanction, rather than genuinely embracing any new approach. On the other hand, seasoned administrators will have seen so many new initiatives, it’s no wonder if there’s a certain amount of jaundice around.
I worry too about whether the views of other key players – local authorities and primary care in particular – will be given equivalent weight to those of ICBs and the secondary care sector? The Local Government Association, for example, says “Adult social care will be central to the success of neighbourhood health, through its role in neighbourhood teams, centres, and wider neighbourhood working”[5]. The National Association of Primary Care (NAPC) “strongly supports the direction towards neighbourhood-based models of care” but advises on the steps needed for “collaboration to be meaningful”[6] .
And I worry about whether funding will actually be realigned enough from hospitals to neighbourhoods. And whether the public and patients will be genuinely engaged in the design of neighbourhood care for their local area.
I do, however, think that it’s the right focus to continue to look at ways to integrate services, both for the benefit of patients so they are not pushed from pillar to post, and with the aspiration that it will lead to efficiencies and better use of whatever funding exists. It’s another matter whether integration can truly work when, for example, the culture and funding streams for the health and social care sectors seem to be very different.
What this particular patient would like to see
I would like to see three things emerging from neighbourhood health:
- Outcomes: patients and the public noticing improvements in the services they receive, measured not only by data but by personal experience. And with transparent accountability for improvements being to local users, not just administratively and behind the scenes to NHS England and the Department of Health and Social Care
- Processes (integration): barriers being broken down both within and between the health and the social care sectors at all scales (via more relationship-building and people skills, less paperwork and fewer written plans?)
- Processes (transparency and involvement): patients and the public knowing what’s going on locally. Seeing whatever steps are proposed to deliver neighbourhood health, so we can be aware of, and contribute to shaping (and supporting?), the local changes to our And trusting they’ll be genuine compliance with the statutory guidance Working in partnership with people and communities[7]. As the King’s Fund describes one component of neighbourhood care: “Community-led approaches to care: making the voices of people and communities central to how health and care services are designed, delivered and evaluated”[8].
Final comment – top down v. bottom up
The 10 Year Plan says
“Neighbourhood services will be designed in a way that reflects the specific needs of local populations. While we will be clear on the outcomes we expect, we will give significant licence to tailor the approach to local need”.
From a local patient perspective, there has to be a question-mark over whether this principle of subsidiarity will be fully manifested when the NHSE’s 2025/26 Neighbourhood Health Guidelines say
“The focus in 2025/26 should be supporting adults, children and young people with complex health and social care needs who require support from multiple services and organisations”
followed by a list of nine strategic actions to be taken in the year that many neighbourhoods were just being established and an extensive list of six core components of a neighbourhood health service with all sorts of supporting guidance? And the Model Neighbourhood Framework has still to come down the track.
Mike Etkind is among other things chair of a GP surgery patient participation group, a volunteer with his local Healthwatch, formerly a representative on NHSE’s Primary Care Community Engagement Strategy Group, a public contributor for various healthcare research, and a member of the expert by experience group for the primary care curriculum at Oxford University medical school. All views are his own.
[1] Medium Term Planning Framework – delivering change together 2026/27 to 2028/29 . The MTPF also talks about taking steps “this winter”. And the 10 Year Plan says single and multi-neighbourhood contracts will be introduced by early 2026. On the other hand, the NNHIP refers to a “test-and-learn approach in partnership with communities” which suggests a more measured pace
[2] Neighbourhood health guidelines 2025/26
[3] 10 Year Health Plan for England: fit for the future
[4] NNHIF welcome pack . NNHIP is led by DHSC and NHSE in partnership with PPL (management consultancy), NAPC, and the NHS Confederation
[5] Local Government Association Health and Wellbeing Committee 14 October 2025
[6] The Future of General Practice: NAPC’s Perspective – NAPC
[7] NHS England » Working in partnership with people and communities: Statutory guidance