Delivering a neighbourhood health service: what the 10 Year Health Plan means for local integration
The government’s 10 Health Year Plan has put the establishment of a neighbourhood health service front and centre. This will help deliver a model of care that is preventative and better supports those most in need, including those with long-term conditions who regularly come into contact with different health and care services. The government is determined to put an end to ‘hospital by default’ and hopes its alternative – the neighbourhood health service – will provide more personalised and coordinated care, thereby leading to better patient outcomes, more cost-effectively. But the concept is neither new nor radical, prompting questions over what is likely to turn ambition into reality this time.
In this long read, we unpack the 10 Year Health Plan’s vision for a neighbourhood health service and examine what’s needed to make neighbourhood working a success. With questions swirling over neighbourhood health delivery models, we shed light on their features, merits and drawbacks.
We fully support the commitment to shift more care out of hospitals and into the community. Boosting neighbourhood health services is a vital step. While there is a lot in the plan that will feel familiar – with successive governments setting similar aims – there are a number of ambitious policy ideas, backed by important financial and regulatory enablers.
Following publication of the 10 Year Health Plan, the focus will now shift to its implementation – with the government announcing the launch of the National Neighbourhood Health Implementation Programme. From September 2025, the Department of Health and Social Care and NHS England will work with 42 selected sites, to accelerate the work that is planned or already happening in many areas of the country, through learning together, sharing solutions, tackling challenges and delivering improvement.
A taskforce chaired by Sir John Oldham, senior adviser to the health and social care secretary, will oversee and govern the programme. A set of four enabler groups – focusing on data/ digital, finance, estates and workforce – will examine common barriers to implementation that arise through the programme. The NNHIP will also be joined up with parallel national 10 Year Health Plan delivery work.
With this shift in focus, health leaders are seeking clarity on the core principles, intended outcomes and essential functions of neighbourhood models nationally. The detailed design and local delivery arrangements will be best determined by each area based on its context and relationships – in line with the more permissive operating model articulated in the ten-year plan.
An end to ‘hospital by default’
The plan intends to end ‘hospital by default’ and sets out the neighbourhood health service as the alternative. Neighbourhoods, multidisciplinary and multi-provider teams working in local communities and often co-located, should end fragmentation and ‘one size fits all’ care.
By 2035, the plan intends for most outpatient care to happen outside of hospitals. New neighbourhood health centres (NHCs), which house and co-locate neighbourhood teams, will be rolled out to bring tests, post-operative care, nursing and mental health teams closer to people’s homes.
Building on the recent neighbourhood health guidance, the plan outlines the preventative principles 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.
To enable the shift, the plan outlines a number of core components (see Figure 1 and our member briefing for more detail):
Figure 1: The shift to neighbourhood care
General practice at the forefront
The government has put general practice at the forefront of its vision for neighbourhood health, reiterating its manifesto commitment to ‘bring back the family doctor’, ‘end the 8am scramble’ and ‘train thousands more GPs’. General practice and community and mental health services will be critical components of neighbourhood health. But these services are under immense pressure to meet the demands of an ageing and increasingly sicker population, and lack the capacity to lead this shift without further support.
Health leaders will hope that the planned refresh of the Long Term Workforce Plan will outline how overstretched primary care and community services will be resourced or empowered to take on expanded leadership roles in neighbourhood health and develop the skills they will need to co-create services alongside communities.
Neighbourhood provider contracts
However, it is clear from the plan that the government’s vision goes beyond general practice. A core component is the introduction of two neighbourhood provider contracts, set to roll out from 2026. The single neighbourhood provider contract maps onto the primary care network (PCN) population footprint of 30,000-50,000, while the second type, ‘multi-neighbourhood provider’ contracts, will be used to cover populations of 250,000 or more. The ambition here is to unlock new benefits of scale through joined-up back offices, data analytics and quality improvement infrastructure.
The government expects to see at-scale providers – include primary care provider collaboratives and federations – taking on this contract and expanding their ability to support general practice to establish strong infrastructure and deliver at-scale interventions using population health data. This new contract also supports areas which have chosen integration models to contract acute, community or mental health trusts to coordinate and deliver neighbourhood health. We are clear that where NHS trusts assume responsibility for neighbourhood health services, this will need to be done in true partnership with local organisations and with a focus on communities and improving the health of their local population – rather than reducing the pressures on existing services.
For both contracts, the devil will of course be in the detail. Indeed, multi-neighbourhood providers might evolve into something previously seen in the 2015 vanguard programme.
Integrated health organisations
The 10 Year Health Plan introduced the possibility for the very best foundation trusts to become integrated health organisations (IHOs). These IHOs would have the opportunity to hold risk-weighted capitated contracts to improve the health outcomes for their local population and will be able to reinvest the savings from allocative efficiency into better care, new capital projects, digital transformations, new partnerships or even commercial support for start-ups and small and medium-sized enterprises with significant promise.
The move towards a plurality of provision is another significant opportunity for our members, as it will encourage the level of collaboration and cross-sector working needed to deliver neighbourhood health
A new NHS operating model lies at the heart of the plan, which devolves and empowers local leaders and communities – a move which we have long called for. The move towards a plurality of provision is another significant opportunity for our members, as it will encourage the level of collaboration and cross-sector working needed to deliver neighbourhood health and other possibilities, including IHOs. Integrated care boards (ICBs) will become even more significant institutions, playing a central role in shaping the market.
However, providers and ICBs will need support to develop the capabilities needed to take on these new roles. There also needs to be a route for at-scale primary care and non-statutory providers to become IHOs, which the current restriction of only NHS organisations could hinder.
What a neighbourhood health service is – and isn’t
Defining ‘neighbourhood’
For citizens, a neighbourhood is not strictly defined by a consistent geography or population size – it can range from a few streets to tens of thousands of people. What matters is how residents perceive their neighbourhood based on local relationships, geography, history and shared experiences.
Public services tend to define neighbourhoods on larger scales, often based on statutory or service boundaries – such as primary care networks or council wards – which may not align with how communities self-identify. Building a consensus around geographic borders in this context is difficult.
Instead, statutory services are developing more localised models and approaches that use economies of scale and opportunities for integration to support local care with targeted teams and activities at smaller footprints based on local needs. This ensures that there is equitable access where needed, preventing gaps in service provision while working at a footprint that responds to and works with communities, fostering familiarity and strong relationships between public services and communities.
The vision for a neighbourhood health service aims to bring care closer to communities, end the current fragmentation of services and convene a multi-disciplinary range of professionals into patient-centred teams
While welcome, the 10 Year Health Plan’s vision for a neighbourhood health service is not a radical new blueprint for health and care. Many of our members are already working in this way.
Neighbourhood working is not just about the location of services but improving the population’s health. Our previous work has demonstrated a diverse range of approaches, including system-wide approaches, reflecting the important role of primary care and general practice, with communities at the heart of change, and demonstrating the role of voluntary and community sector (VCSE) organisations.
An effective neighbourhood health service requires integrated health and care services and a workforce at the most local level – within neighbourhoods. Although some places have already made progress in developing an integrated local approach to NHS, social care and VCSE, the direction of travel represents a new way of working, where integrated working is the norm rather than the exception. The aim is to:
- prevent unnecessary hospital and care home stays.
- strengthen community and primary care, enabling the delivery of care closer to home
- connect citizens to wider services including social care, VCSE and public health.
For the NHS, this means being a better partner to providers of health and care services inside and outside of the NHS. It also means improving certain capabilities systems, infrastructures and skills. NHS England guidance published in early 2025 set out six core components of neighbourhood health:
- Population health management
- Modern general practice
- Standardising community services
- Neighbourhood multi-disciplinary teams
- Integrated intermediate care
- Urgent neighbourhood health services.
These are set out as the foundations of enabling neighbourhood health and neighbourhood working to thrive alongside a focus on leadership, public service reform and improvement support.
Our view on neighbourhood working
Neighbourhood working is both a mindset and method. It is not just about delivering care in new places, but designing care differently – locally informed, community-led and coordinated across systems. It centres on trust, relationships and community insight. It enables services to be co-designed with local people and tailored to each area’s social, cultural and environmental context.
We refer to three essential components of a neighbourhood health approach:
The operating approach for a neighbourhood health service
To make neighbourhood working successful, there must be a clear and coherent relationship between a supportive infrastructure (integrated care systems), frontline care (team-based care) and communities.
Supportive infrastructure
This consists of key roles and functions that operate across system and place levels.
Figure 2: Key roles and functions across systems and place
Frontline care
At its core, neighbourhood working means local teams delivering care within communities, working with and for citizens. These frontline teams include professionals from across the breadth of primary care (general practice, pharmacy, optometry, dentistry), secondary care, community health, mental health, social care, housing, education and the VCSE sector. Different teams will have different expertise in the core team and wider specialist expertise they can draw on based on the issues trying to be tackled.
Neighbourhood delivery teams are not just implementers – they are agents of change
What makes this model powerful is its local adaptability. Neighbourhood teams operate at the scale that makes the most sense for their populations. Where it works most effectively, they respond quickly to emerging needs, mobilise resources, and build strong, trusted relationships within their communities. Citizens and communities should be at the centre of these teams, as active partners in the design and ongoing delivery of services.
Neighbourhood delivery teams are not just implementers – they are agents of change. Their close connection to residents gives them real-time understanding of what’s working, what’s missing and what could be improved. But they cannot do this alone. They need supportive infrastructure that removes barriers, enables innovation and helps coordinate and sustain their work.
Communities
Neighbourhood working also means increasing community resilience and building on trusted bodies and familiar expertise that are rooted in communities, such as general practice, community pharmacy and the local voluntary and community sector. For this new model of working to be successful, we need to strength what is trusted, familiar and working – but also respond to deficits in community social capital. This is particularly important if we are going to tackle deep-rooted health inequalities.
The approach in practice
Case study: Haringey Multi-Agency Care and Coordination Team
Haringey’s Multi-Agency Care and Coordination (MACC) team is an early example of an integrated neighbourhood team model, driven by the fundamental first question of “what matters to you?”. It brings together more than 20 professionals from a wide range of disciplines. The team, based at Lordship Lane Primary Care Centre, includes staff from primary care, adult social care, adult community services, secondary mental health care and the voluntary sector.
These professionals work together to identify, plan and coordinate care for people with complex needs. Most people supported are older adults living with frailty, but not exclusively. It is a partnership between Whittington Health NHS Trust, Haringey GP Federation, North London NHS Foundation Trust (which provides specialist mental health services), Haringey Council and Bridge Renewal Trust. It works across three neighbourhoods – East, West and Central – in line with other local community services.
Their goal is to keep people well, help them work towards what matters to them, and prevent avoidable hospital visits or crises.
The model
Referrals to the MACC team are triaged by an experienced senior clinician within 24 hours. They review information across multiple record systems (GP, hospital and social care) and use professional judgement to direct the person to the right support stream:
- Stream 0: Weekly multidisciplinary team meetings. A forum for discussing complex needs and agreeing shared actions.
- Stream 1: Outreach and early identification. Case-finding people with mild to moderate frailty from GP lists for early support.
- Stream 2: Escalations from stream 1. Managed by a single professional. Includes people whose referrals were rejected elsewhere or don’t meet criteria for other services.
- Stream 3: Prompt action on rising risk. Joint working by two or more professionals to address complex needs early and avoid crisis.
All referrals are responded to, even if not suitable for the MACC team. People are referred on or signposted to the right service. Referrals are only returned to the GP if no other option is available.
Impact
The MACC team has supported more than 6,000 adults since its formation in 2020 and reduced emergency department visits and hospital admissions by 40 per cent – a cost saving of around £1 million in acute activity alone.
This figure does not include likely savings in GP appointments, ambulance callouts or other parts of the system, thanks to improved self-management and wellbeing.
The team’s focus on reducing health inequalities has contributed to its success. More than 30 per cent of referrals come from the most deprived wards in Haringey.
The service is also well regarded by those who have experienced it:
- 94 per cent of patients said their support was well coordinated
- 91 per cent felt they received the help they needed
- 62 per cent said their health had improved or was better managed
- 71 per cent felt more able to manage daily living.
The team’s NHS Staff Survey results are also well above average, demonstrating that if you build services around what patients really want and need it creates a virtuous circle for them and the workforce alike.
Case study: Buckinghamshire Healthcare NHS Trust
Partners in Buckinghamshire have a shared ambition to help people live healthier and more independent lives.
Buckinghamshire Place has focused on joining up health and care since 2023 and neighbourhood working since April 2024. To date the joining-up care programme has delivered a 35 per cent reduction in bed days lost from people remaining in hospital not meeting the criteria to reside – from just under 4,000 per month to March 2023 to under 2.500 since February 2024.
The programme includes:
- Health, care and VCSE partners developing a fully integrated Transfer of Care Hub. The hub is a multidisciplinary coordination centre, bringing together professions from health, social care and housing and the voluntary sector to support sage and timely patient transitions out of hospital. The hub operates twice daily, both in-person and virtually, reviewing referrals to decide the best discharge route, whether it’s returning home, entering an intermediate care facility, or receiving support from voluntary or community services.
- General practice, social care and community services aligned to support 163 people through 20 discharge hub beds through an integrated MDT.
Care providers, social care and community teams work together in an integrated home first service, supporting discharge and admission avoidance. The Home First team consists of case managers, physiotherapists, occupational therapists and clinical support workers. The case manager coordinates the patient’s journey from the point of referral to discharge. A single joint assessment is completed and a free, short-term care package is sourced. A therapist will then assess a patient home and assess if longer term care may be needed.
Support from the system and place-level infrastructure should enable frontline action, not control it. This is where the neighbourhood health provider, described in the recent Model ICB document, plays a critical role, acting as the interface between strategic commissioning and delivery.
In simple terms:
- Infrastructure support = the backbone (strategy, systems, place, neighbourhood health provider).
- Delivery = the frontline (care teams responding proactively to citizens and communities)
Full details of the health system operating model, including a helpful graphic which includes national and regional roles, can be found in our recent report. The report explores how the health system and centre could work together to deliver a more integrated and devolved healthcare model.
Neighbourhood health models
It is perhaps no surprise that the concepts of a neighbourhood health provider, multi-neighbourhood provider and integrated health organisation have led to more questions than answers over the past few months. The neighbourhood health provider and multi-neighbourhood provider have been described in contractual terms in the 10 Year Health Plan – and we expect these to be rolled out from 2026.
The NHP is best understood as a function, not a form such as a new organisation or governance structure
The term neighbourhood health provider (NHP) can be confusing. That’s because most of this work is happening at place level – and that is where it needs to be optimised. Place is where joint decisions are made, partnerships are formed and support functions come together to enable care in neighbourhoods. The NHP is best understood as a function, not a form such as a new organisation or governance structure. It provides the support system that makes neighbourhood working possible. Below, we explore three NHP examples: the alliance model, primary care model and system-wide model.
Alliance model
Surrey Downs Health and Care
Surrey Downs Health and Care (SDHC) is a collaborative alliance originally formed to deliver adult community health services across the Surrey Downs area. The partnership comprises several NHS organisations, including three GP federations – GP Health Partners, Dorking Healthcare and Surrey Medical Network – all representing local general practices. Other key partners include Epsom and St Helier University Hospitals NHS Trust and Surrey County Council.
Epsom and St Helier University Hospitals NHS Trust acts as the host organisation, providing essential infrastructure to support the alliance. However, all staff members identify as part of Surrey Downs Health and Care, rather than solely aligned with any single partner organisation. This collective identity underpins the alliance’s integrated working model.
Historically, care provision in the area was fragmented, with distinct boundaries between services delivered in patients’ homes, GP practices, and hospitals. The formation of SDHC aimed to overcome this fragmentation by fostering closer collaboration between primary, community, and secondary care providers.
Through the alliance, community medical teams have been established. These are led by a clinical director with a lead GP, lead nurse and operational manager in each PCN and supported by multidisciplinary teams, including community matrons, district nurses, and mental health practitioners. This team-based approach ensures a more coordinated and person-centred model of care.
SDHC was founded on the principle that local people should receive high-quality care in the most appropriate setting. By drawing on the combined expertise of its partner organisations, the alliance aims to improve patient outcomes and ensure that individuals can access the support, care, and treatment they need more easily than ever before.
A core feature of the SDHC model is the delivery of care closer to people’s homes and communities. This is achieved through integrated neighbourhood teams (INTs), which enable proactive, place-based care and better integration with wider health and care services.
Primary care model
Milton Keynes Primary Care Collaborative
Milton Keynes Primary Care Provider Collaborative (alliance) is a place-based collaborative within the wider Bedfordshire, Luton and Milton Keynes Integrated Care System. The system has four place-based partnerships, but Milton Keynes is currently the only one to have a primary care provider collaborative.
The collaborative has established itself as a community interest company and the alliance includes the out-of-hours provider, the primary care networks and the LMC – providing an alliance of at-scale providers rather than individual practices. It has an MOU with the ICB and has begun discussions with pharmacy and dentistry, although they are not formal members yet, and have recently been joined by their local authority as a full member on the collaborative.
Greater Manchester Primary Care Provider Board
Since 2015, the Primary Care Provider Board (PCB) has developed the strategy for the provision of primary care by reflecting the needs of local providers. This leads to transforming care, reducing variation and improving patient experience and outcomes as well as quality improvement across PCNs and federations. It also provides support, development and wellbeing for over 20,000 staff.
The 65 PCNs, in partnership with dentistry, community pharmacy, optometry and audiology, reflect the neighbourhood footprints of the collaborative. These providers are small enough to have a comprehensive understanding and connection to their communities, while being large enough to support multidisciplinary team working. Critically, they are large enough to support resilience within their providers to meet local demands and test out new ways of working with a wider set of partners to address the causes of poor health. Operating in a multidisciplinary way through integrated neighbourhood teams (INTs), they facilitate the provision of, and access to, place-based care, with local services responding to local need.
Using neighbourhood profiles and risk stratification to gain a better understanding of populations at place and neighbourhood level, multidisciplinary teams identify regular users of unplanned attendances through case finding approaches and put in place solutions to prevent further admissions and maintain independence at home or in the community. The place level provider board supports remote monitoring at home and facilitates digital connectivity through patient held records into Greater Manchester Care Record care plans. To date, this way of working has enabled the more mature of these teams to become self-directing in the design and development of services which are responsive and effective in meeting the needs of the local population.
System-wide model
Birmingham and Solihull Care Collaborative
Birmingham and Solihull’s Community Care Collaborative is a partnership between primary, acute, community, mental health, social care and ambulance service, as well as the voluntary and community sector. The collaborative is hosted and based at the community trust, Birmingham Community Healthcare NHS Foundation Trust. Primary care is a key driver in the collaborative and is connected to decision-making through locality based GP clinical leaders and the GP Partnership Board.
The collaborative is focused on five key priorities:
- Integrated teams in neighbourhoods and localities
- Intermediate care
- Long-term conditions – improving pathways, self-care and prevention.
- Supporting primary care development, delivering the BSOL Primary Care Strategy and Transformation Plan – focused on reducing variation and practice support.
- Children's community services
The East Birmingham Locality and Neighbourhood Team operates from the Locality Care Coordination Centre at Washwood Heath Health and Wellbeing Centre. The hub and INTs oversee urgent care demand, working collaboratively with GPs, care homes and Birmingham Heartlands Hospital to coordinate individuals’ community care. They also deliver direct, patient-facing services that provide same-day appointments for those requiring immediate support.
The hub, which also benefits from a co-located urgent treatment centre and community diagnostic centre, is particularly focused on improving care for people with high intensity use of emergency departments (locally known as frequent service users), by offering personalised support at the neighbourhood level.
In their first year an evaluation of the impact of the INT demonstrated:
- GP attendances – down 31 per cent
- A&E attendances – down 20 per cent
- Inpatient spells – down 21 per cent
- Outpatients – down 25 per cent
- Community contacts – down 15 per cent
- Social care packages – down 77 per cent
- Mental health provision – up 47 per cent
What the neighbourhood health provider is – and isn’t
The ‘integrator’
The neighbourhood health provider is not a new board or another leadership tier. It is a function – delivered by an existing organisation(s) that supports frontline teams by coordinating funding, data, workforce, estates, and other enablers. It works as a partner for services commissioned by the ICB and shaped through place-based strategies, using scale and partnerships to drive local impact.
The NHP (or integrator as set out in A Neighbourhood Health Service for London), will be vital to ensuring the effective delivery of neighbourhood working – operating at a level of scale while drawing on local knowledge, experience and relationships.
To be effective, the NHP must maintain a deep connection to existing place-based partnerships. It will need to:
- translate strategic intent into operational delivery
- inform future strategy and commissioning through frontline delivery experience
- feel accountable to the ICB, place-based partners and local communities, not just its own organisation.
The NHP/integrator will host the identified integration functions required to enable primary, community, mental health, acute specialist, local authority, VCSE and other partners to work effectively at neighbourhood level to deliver the outcomes specified in the neighbourhood contract.
Crucially, they will have to be of sufficient scale to hold contracts, manage related budgets and provide required infrastructure, including around data sharing, workforce, estates and digital.
In some places, these functions will be hosted by a single organisation with the capacity and capability to support neighbourhood working across all neighbourhoods. In others, integrators may work with one or more local partners to provide the range of required support. In either model, it will be important that there is strong multi-agency governance that reflects the range of partners involved in the delivery of services and a clear line of organisational accountability to the place partnership or system for ensuring the neighbourhood health service can function effectively.
A strong NHP delivers essential support to neighbourhood teams
Where strong place-based partnerships do not exist, the NHP should bring NHS, social care, VCSE, and other providers together into a shared governance and care approach. In this way, the NHP acts as the bridge between strategic commissioning and neighbourhood-level care, enabling neighbourhoods to become the ‘engine room’ of integrated care. It supports:
- Consistency across neighbourhoods
- Flexibility to respond to local need
- Integration without duplication or parallel systems.
A strong NHP delivers essential support to neighbourhood teams, drawing on place-based working together. Its key functions may include:
- Governance and accountability: provides shared leadership across the NHS, local government, and VCSE; holds delegated authority for neighbourhood-level care; creates shared accountability for outcomes, budgets, and risks.
- Funding, contracting and pooling: manages ICB-commissioned contracts and pooled budgets – often through Section 75 arrangements – with local authorities and other partners. Can act as a commissioner or subcontractor, funding VCSE partners and enabling flexible local offers.
- Service design and consistency: supports the design of place-based service offers, co-produced with partners and communities. Where appropriate, helps ensure consistency and equity in service models across neighbourhoods, without removing local flexibility.
- Bridging with secondary and specialist care: acts as a connector, bringing together community-based teams and relevant secondary care expertise into neighbourhood teams.
- Data and digital support system: supports data sharing and analytics for population health, risk stratification, and planning. Enables use of digital tools at the neighbourhood level.
- Workforce coordination: aligns staffing across primary care, community teams, secondary care, mental health, social care and VCSE services. Helps build multidisciplinary capacity and supports integrated leadership development and people working in joint roles or moving between organisations to meet local needs
- Estates and support system: helps secure and manage shared spaces such as neighbourhood hubs and supports partners to use buildings more flexibly and efficiently.
How each sector can support neighbourhood working
Regardless of whether an organisation is acting as the neighbourhood health provider or not, there is an important role for each organisation to play. A successful neighbourhood health service requires distributed leadership, working together and contributions from across the system. While some of the infrastructure may be designated to a specific provider or collaboration of providers at place level, the effectiveness of neighbourhood working depends on aligned action from all sectors around a common purpose.
Below is an outline of how each sector can play a pivotal role in supporting neighbourhood working. These roles focus on partnership, innovation, shared leadership and embedding population health approaches in everyday practice.
1. Primary care
Primary care is central to the success of a neighbourhood health service. It provides continuity, access and trusted relationships that make person-centred, proactive care possible. But to fulfil this role in the future, primary care must evolve as both a place-based partner and a strategic actor in integrated neighbourhood care.
Engaging with primary care at both place and system levels – through GP federations and primary care collaboratives – provides broader geographical coverage and supports primary care organisations operating at individual provider or neighbourhood levels.
While alignment with existing PCN footprints can be beneficial, many PCN boundaries do not neatly map to natural neighbourhood footprints. PCNs may therefore need to work across boundaries to correspond to geographies that are meaningful to citizens and other key partners. Many PCNs around the country are delivering the core components of neighbourhood health through risk stratification of their patients and wrapping services with the right professionals around them.
General practice remains the clinical backbone of neighbourhood teams. GPs bring a unique population lens, acting as medical generalists who understand both individual histories and community trends. In a neighbourhood approach, general practice is not working alone – it is embedded within multidisciplinary teams that include social care, mental health, VCSE and community services. The role of general practice will increasingly focus on proactive population health management and relationship-based care.
The future of general practice involves working at a higher level of integration – with shared care planning, pooled workforce and interoperable digital tools. It also means moving away from reactive, transactional consultations to an approach that enables continuity, time to care and multidisciplinary problem-solving. New roles such as care coordinators, health coaches and community link workers are vital, but they must be deployed in a way that supports whole-team working rather than diluting core generalist expertise.
Community pharmacy can play a key role in neighbourhood health by offering accessible care on the high street. It can support prevention, early intervention and medicines optimisation. Community pharmacy is already demonstrating how it can support a more personalised service for patients and help to reduce demand on other parts of the system. They can contribute to multidisciplinary neighbourhood teams, supporting long-term condition management, and can be key to tackling health inequalities.
As part of community provision, dental teams not only provide oral health care but also identify signs of disease such as diabetes, heart disease and oral cancers. Their work can support neighbourhood health by addressing inequalities – particularly in underserved populations where poor oral health is more prevalent – and by promoting preventative care through education and early intervention.
Community optometrists and audiologists can help identify conditions such as glaucoma, macular degeneration, hearing loss and signs of systemic disease, such as diabetes and hypertension. There is evidence from those areas where community optometry and audiology are commissioned of a reduction in demand on other parts of the system. By working in partnership with other health and care providers they can support independence, communication and quality of life – particularly for the elderly.
Primary care-at-scale – through GP federations, collaboratives or alliances – will be key to delivering system support for neighbourhood care and in many areas can be the neighbourhood health provider. This includes bringing together general practice, community pharmacy, dentistry and optometry to operate in a coordinated way across place. They can host shared services, provide analytical support, employ staff and support quality improvement in providers. They offer the organisational maturity to interface with key partners in the system, aligning the voice of primary care with wider system transformation.
A key enabler for effective primary care within neighbourhood health services is the reform of Section 75 of the NHS Act. Reform of pooled budget arrangements would facilitate closer working together between primary care and statutory bodies, including local government, in delivering integrated neighbourhood health services.
2. Community trusts
Community trusts are well placed to act as support system integrators at place level. Operating at scale and with a broad multidisciplinary reach, they already host many of the enabling functions required to support care in neighbourhoods, such as coordination of shared workforce models, digital tools, and population health data support system. In a neighbourhood health service approach, they can offer a “backbone” for integrated neighbourhood teams (INTs) to develop around, particularly through shared governance and service development roles across health as well as links into adult social care.
The community sector is also already at the forefront of many key elements that neighbourhood working will require, such as proactive care for frailty, rehabilitation and long-term conditions. Working with PCNs and VCSE partners, community trusts can co-locate teams, embed relational approaches to care, and extend their reach through neighbourhood-based multidisciplinary models. Their leadership is vital in shifting from transactional interventions to preventative, place-based support.
Furthermore, community trusts are well versed in making integration happen. With many providers already integrated with the acute sector and or mental health, uniting care across disciplines is a capability which community trusts have extensive experience; making the most of this could bring significant system-wide benefits.
3. Acute providers
For acute trusts, supporting neighbourhood working means moving beyond episodic hospital-based care and becoming active contributors to population health and place-based transformation. Co-designing service models with patients and communities and building relationships with key partners, including those in primary care and the voluntary sector, will be key in ensuring robust governance models for neighbourhood working. This includes aligning discharge planning, virtual wards and specialist input with neighbourhood teams to reduce avoidable admissions and improve transfers of care. Neighbourhood health services create opportunities for acute providers to partner more closely with community teams.
In the support system space, acute providers can bring specialist expertise into multidisciplinary neighbourhood models – particularly where outpatient transformation or diagnostics can be delivered closer to home. Through shared data and joined-up care planning, they also play a critical role in shifting from reactive to preventative models and in enabling integrated care across settings.
4. Mental health providers
Mental health providers are critical to embedding psychosocial, preventative and recovery-oriented care into neighbourhood models. They bring specialist capabilities – such as crisis response, trauma-informed practice and complex needs management – that are essential in supporting people holistically. Equally the vast majority of their services are already community based. Their integration into neighbourhood teams ensures timely access to support, earlier intervention and continuity across the care journey.
Neighbourhood working creates a strong opportunity to integrate physical and mental health care more closely. In the neighbourhood health service approach, mental health providers contribute both to delivery of care and supporting the system. Their staff are embedded in neighbourhood teams alongside GPs, social care and VCSE partners. Increasingly, 24/7 community mental health hubs are being developed to offer local, round-the-clock access to mental health support, helping to divert people from A&E and improve early intervention. These hubs – co-designed with communities – can become vital physical assets within a neighbourhood health support system.
Beyond NHS services, mental health support is often delivered by peer-led, voluntary and non-clinical organisations. A thriving neighbourhood approach must value and include this non-statutory mental health expertise, which brings a lived experience lens and deeper community trust. Mental health providers therefore have a dual role: delivering care and supporting the integration of broader mental health assets into a whole-place approach.
5. Ambulance trusts
Sandwiched between rising demand from the public and increased difficulties in transferring patients into acute settings, ambulance services are already exploring how neighbourhood working could change how and where the NHS provides care. Initiatives such as urgent community response and increased cooperation with primary care are strong examples of how ambulance trusts view neighbourhood working as key to both relieving the pressures upon their resources at the same time as ensuring that patients receive care faster, in more localised settings, and at less cost to the NHS.
Ambulance trusts also have the potential to contribute to prevention activities as is currently seen through programmes such as targeted cardiovascular screening in areas of highest deprivation (and therefore healthcare need).
The enablers for neighbourhood health are especially relevant to ambulance trusts. New technologies, such as consistent and accessible electronic patient records, are already central to the sector’s ambitions to improve its own productivity. Similarly, the use of remote monitoring and wearable technologies to allow community providers and primary care to intervene proactively when needed amongst high-risk patients. This aligns with ambulance services’ long-standing aim of minimising conveyances wherever possible by linking more effectively with non-emergency care.
6. VCSE sector
The VCSE sector is central to delivering the social approach of health at neighbourhood level. Their deep roots in local communities, flexibility and ability to build trusted relationships make them essential partners in designing and delivering care that reflects local priorities and the lived experiences of those they serve. Within a neighbourhood health service, VCSE organisations help bridge gaps between statutory services and communities, particularly for those facing exclusion, inequality, or complex life circumstances.
Their role includes direct support, such as peer-led early intervention and crisis support in mental health services, debt advice or community connectors, as well as shaping strategy, governance and co-production. To fully participate, VCSE organisations must be resourced through core support system funding, included in shared outcome frameworks, and supported to sit as equal partners in neighbourhood teams and system planning structures.
7. Local government
Local authorities bring democratic legitimacy, public health expertise and responsibility for many of the wider determinants of health – such as housing, education and social care. Local authorities are also actively leading and shaping new and innovative approaches to public service reform, many of which are fostered around the very same local communities. In a neighbourhood health service approach therefore, they are critical co-leaders of both the support system support and the care itself. Their involvement ensures services are tailored to place and built around what matters to local people, not just clinical need.
They can lead or support neighbourhood governance, co-fund integrated teams through pooled budgets, and contribute to shared population health planning. Their commissioning power in social care and children’s services complements NHS roles, making true integration possible. To realise this vision, local government must be recognised as an equal strategic partner in neighbourhood health support system and decision-making.
8. Adult social care
Adult social care (ASC) and carers are essential for neighbourhood health services to work effectively. While local government responsibilities are outlined above, the distinctive contribution of ASC – including unpaid carers – requires fuller recognition in both design and delivery.
Social care providers, including both local authority and independent sector organisations, bring a deep understanding of personalisation, daily support and continuity of care. Their insight into the home environment and the social determinants of physical and mental health is vital in ensuring integrated neighbourhood teams can respond to complex needs – especially for those living with frailty, disability or chronic conditions.
To support this, social care must be fully embedded in neighbourhood multidisciplinary teams and joint care planning processes: not solely as a recipient of hospital discharges or community referrals, but rather as a co-leader in proactive, preventative care.
Unpaid carers – often family members or close friends – are frequently the primary caregivers for individuals with long-term health or support needs. Neighbourhood models must actively identify, support and engage carers through system navigation, training and emotional wellbeing offers.
Supporting carers bolsters the resilience of the whole system. Their lived experience also brings valuable insight, which should be harnessed through local forums and co-production mechanisms. Similarly, the health needs of carers themselves should also be taken into account, for both their own benefit and that of those for whom they care.
A fully integrated neighbourhood health service cannot exist without including social care and carers. Their knowledge of local need and the depth of their understanding of those they serve is an invaluable asset to optimise neighbourhood working.
9. ICBs and place-based partnerships
ICBs are central to the ambition of delivering neighbourhood health, as the strategic commissioner of neighbourhood health providers, with the freedom to commission wider neighbourhood health services to complement the core neighbourhood delivery. ICBs are tasked with developing population health plans drawn from local neighbourhood health plans generated by health and wellbeing boards and associated partners.
No direct reference is made to place-based partnerships in the 10 Year Health Plan, however, on a functional level, well-established place-based arrangements will be critical to making appropriate commissioning decisions through ICBs. Additionally, providers working across a place geography will hold multi-neighbourhood provider contracts.
There is substantial variety offered in how to generate the most effective neighbourhood eco-system to unlock improved healthcare access and health outcomes at a local level. Selection of the most appropriate localised approach should be governed by locally agreed plans and priorities, understanding of local assets and clear identification of barriers and challenges; insight which should be shared by health and wellbeing boards and place-based partnerships to inform strategic commissioning of neighbourhood health.
Supporting implementation; scaling innovation
The 10 Year Health Plan has been published at a critical moment for both the NHS and wider health and care system. The bold ambitions should be welcomed, and our members stand ready to work in partnership with the government and NHS England to make the vital reforms needed to put the NHS on a long-term sustainable footing.
Delivering on this ambition will require a commitment of sustained investment in digital and estates, support for the NHS’ workforce, and a commitment to decentralise control by empowering local leaders to do what is best for their communities. Neighbourhood working is not a new concept and, as has been outlined here, many of our members are already delivering or developing neighbourhood healthcare models. Our national footprint and connections, from the centre to the front line, will enable us to support both implementation and improvement in local context and the scale and spread of best practice and innovation nationally.
We are delivering a programme of work with partners to advocate and help support and improve neighbourhood working. Our community of practice brings together leaders from across the country from place-based partnerships, community providers and primary care in facilitated action learning sets to jointly develop their leadership skills and their local neighbourhood health programmes. This support sits alongside our programme of action research in partnership with Local Trust to explore community-led, hyperlocal approaches to health – putting power and funding in the hands of communities themselves.
Over the past 18 months, we have played a leading role in shaping and developing the neighbourhood health policy landscape. We will be continuing to contribute to the implementation of neighbourhood health, ensuring our members’ voice continue to shape national policy. As well as supporting the delivery of the National Neighbourhood Health Implementation Programme and wider 10YP delivery groups, we will be supporting with implementation across all of our member networks.
To drive forward our work on neighbourhood health, a steering group has been set up, spanning the full breadth and depth of our member networks. The group will provide input into our refreshed neighbourhood health influencing priorities, positioning and a forum for ongoing reflection, ensuring members’ insights and perspectives steer our approach.
Further information on our work on neighbourhood working and access to a range of resources can be found at our neighbourhood working hub.
