Neighbourhood Health Framework: what you need to know

Overview                                                 

Neighbourhood health is at the centre of the government’s reform agenda for health and care. The ambition is to 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. 

It is clear that this is not simply about NHS services working more closely together, but the joining up of care across the NHS, local authorities and the voluntary, community and social enterprise (VCSE) sector. Neighbourhood health is a recognition that the transformation of public services will not be successful unless it is accompanied by a more fundamental transformation of relationships between our statutory services and our communities. 

However, this concept is neither new nor radical, prompting questions over what is likely to turn ambition to reality this time. The Neighbourhood Health Framework is intended to provide clarity on the ambitions to further developing and accelerating the approach and ambition for a neighbourhood health service. 

The framework outlines five main aims of neighbourhood health: 

1. Improving people’s health and care outcomes, reduce health inequalities and help them stay well at home.
2. Organising services around the person, with more convenient, personalised and joined-up care.
3. Reduce avoidable demand on acute services – including hospitals and care homes.
4. Cut waste and duplication – integrating services across health, local government and wider partners.
5. Helping the NHS deliver against core targets. 

Measuring the overall success of neighbourhood health 

The framework outlines national minimum goals and objectives, which are complemented by locally developed aims and outcomes, specific to local communities. These will be defined locally through neighbourhood health plans, designed under the collective leadership of the ICB and the health and wellbeing board (HWB). 

During 2026–27, HWBs must work with communities, health and care partners and others to establish whole‑life‑course outcome measures for 2027–28.

National NHS goals, objectives and metrics

To be achieved over the 10 Year Health Plan timeframe, with early progress expected 2026-29. These national goals are based on the Medium Term Planning Framework, and where systems can set out proposals to go further they are encouraged to do so. There is an acknowledgement that metrics are still being developed and will be communicated as part of the usual planning round. This will include any changes and additional metrics as a result of the development of Modern Service Frameworks. 

Goal 1: Improve health outcomes 

Focus on high-priority cohorts (frailty, care homes, housebound, end of life, long-term conditions, mental health, dementia, children and young people) and other cohorts identified by local areas. Key objectives by March 2029:

• 10 per cent reduction in non‑elective admissions/bed days for frailty and housebound cohorts.
• 10 per cent increase in identification of people approaching end of life and a 10 per cent reduction in their non‑elective admissions/bed days.
• 10 per cent improvement in clinical outcomes for major long-term conditions where warranted, and 10 per cent increase in diabetes patients receiving all eight care processes.
• 10 per cent reduction in outpatient appointments for under‑16s and significant progress on reducing community waits.

Goal 2: Improve access to general practice

• 90 per cent of clinically urgent patients seen the same day by March 2027.
• Routine GP access and satisfaction baselined in 2026–27 with local goals set by ICBs in the interim.

Goal 3: Improve experience of planned care

• 25 per cent diversion of referrals via single points of access for ten high‑volume specialties by March 2027, supporting RTT recovery.
• 10 per cent reduction in follow-up outpatient activity by March 2027, with neighbourhood-based follow-up for priority cohorts and cancer metrics aligned with the National Cancer Plan.

Goal 4: Improve urgent and emergency care performance

Objectives by March 2029:

• Reduce non-elective admissions and emergency department (ED) attendances for high-priority cohorts (defined as severe frailty, in a care home or housebound and end of life)
• Contribute towards 82 per cent ED four-hour performance by March 2027, moving to 85 per cent in the longer term.
• Reduce category 3/4 ambulance conveyances for high-priority cohorts by expanding urgent care response.
• Improve discharge efficiency (more patients discharged on their ready date; quicker discharge where delays occur).

Goal 5: Improve patient and staff satisfaction

From 2026–27:

• Introduce new patient experience and outcome measures with year‑on‑year improvement.
• 95 per cent of people with complex needs to have a care plan by 2027.
• New staff experience measures introduced in neighbourhoods with annual improvement trajectories.

Local goals and responsibilities 

Through HWBs, ICBs and local authorities will:

• agree further local benefits and outcomes for neighbourhood health
• tackle local priorities and health inequalities identified in joint strategic needs assessments (JSNAs)
• consider outcomes from:
  • local outcomes framework (health, wellbeing, adult social care, Best Start in Life)
  • adult social care priorities (eg., enabling people to stay at home, reducing care home admissions, improving satisfaction of service users and carers).

They should also align neighbourhood health with wider public service reform, prevention and early intervention, and existing local community structures (eg., area committees, parish councils, Pride in Place boards).

Delivering neighbourhood health 

The framework outlines that ICBs and local authorities, working with other local partners, will make the changes to services to improve routine care, create proactive support for people with complex needs, and provide strong alternatives to hospital-based care.

Neighbourhood health requires better joint planning, shared pathways, alignment of services and deep collaboration with VCSE partners and local communities. ICBs must implement a set of minimum interventions over the next three years which provide the foundation on which to develop local priorities.

Reform agenda 1: Improving routine healthcare access 

Strengthening general practice, through: 

• improving access using new national GP access targets
• incentivising proactive population health management
• increasing use of digital tools such as online consultation, AI triage and ambient voice technology to free clinical time
• reducing bureaucracy through the Red Tape Challenge, improved EPRs, direct prescribing to pharmacy and standardised medication information
• improving GP access to diagnostics via a review of community diagnostic centres

Expanding pharmacy so they become the first point of contact for more patients.

Reforming out-of-hours primary care – the NHS will create a standardised national minimum specification for out-of-hours services connected to NHS 111.

Reform Agenda 2: Proactive care for people with complex needs 

Integrated neighbourhood teams (INTs) will help people stay healthier for longer. The NHS will not define nationally what should constitute an INT, and this will vary based on different conditions and populations to be decided locally. 

Nationally, NHS England will ask ICBs to ensure INTs are set up with an initial focus on: 

• frailty and end‑of‑life care (representing 3–5 per cent of the population but over 25 per cent of non‑elective admissions)
• people with multiple long‑term conditions (CVD, diabetes, COPD, dementia)
• children and young people, with the goal of universal INT access by 2028–29
• people living with cancer; in line with the National Cancer Plan.

In addition: 

• NHS England will produce a best practice guide for NHS frailty pathways
• women’s health hubs will be aligned to new neighbourhood health pathways and structures
• ICBs will grow core community services and work with providers to reduce waiting times
• a new model for planned care for ‘ending outpatient care as we know it’
• standardise the expectation of data sharing between neighbourhood health services and hospitals.

Reform Agenda 3: Deliver better alternatives to hospital care 

Working closely with partners including social care, the NHS will take the following actions:

• Expand urgent community response services, with a focus on reducing ambulance CAT3/4 callouts (especially for end-of-life, frailty, and care home cohorts).
• Increase the capacity of virtual wards.
• Work with local authorities and other partners to increase intermediate care capacity.
• Explore better alternatives to mental health hospitals, including 24/7 open access neighbourhood mental health models.

Implementation and going further

Local systems will be supported by the National Neighbourhood Health Implementation Programme, which aims to build capability, develop infrastructure and identify success criteria for the scaling of these new models. While the framework outlines the minimum expectations, it outlines that ICBs can go further and earlier in services - such as community pharmacy, dental, optometry, learning disabilities and neurodiversity services – as part of their neighbourhood plans. 

ICBs will jointly plan with local authorities and align neighbourhood plans with JSNAs, HWBs and the MHCLG Local Outcomes Framework. Mayoral authorities are expected to support regional coordination and accountability.

The Neighbourhood Health Framework outlines that local systems will operate in an enabling, non-prescriptive way. HWBs will need to set the geography around which services should be delivered. Local areas will also need to consider the footprint of local authority boundaries, taking into account: the local health economy, access requirements, local government structures (e.g. area committees, ward partnerships and parish councils), Pride in Place neighbourhood boards. 

Integrated neighbourhood teams (INTs) will need formal contracts to clarify roles, outcomes, funding and enablers such as data sharing and incentives. Single-neighbourhood providers will deliver services through INTs within a defined single neighbourhood. Multi-neighbourhood providers will play a key role in co-ordinating the delivery of consistent services across neighbourhoods and providers will take on an ‘integrator’ role to ensure there are teams form different providers covering the same neighbourhood footprints. Further guidance on the commissioning of neighbourhood contracts will form part of a consultation paper to be published following the Towards Population Health Delivery Models blueprint. DHSC/ NHSE will also set out the minimum requirements the NHS will expect of governance, leadership and financial discipline of any provider.

The SNP, MNP and IHO (and GMS, PMS and APMS) are all population-based contracts. In a system using all three contractual mechanisms, the ICB, as the strategic commissioner contracts a single IHO for an area. The IHO host then contracts several MNPs. Each MNP works with multiple SNPs, and each SNP works with all local GP practices within its neighbourhood. For more information on how these contractual models relate to one another, see our member briefing. Towards Population Health Delivery Models: what you need to know.

The framework also details the role of neighbourhood health centres (NHCs) and implications for the neighbourhood health workforce and finances.

NHCs will aim address the challenge of poor-quality and fragmented estates by bringing together services in one place, improving efficiency and patient experience. The national ambition is to deliver 250 NHCs by 2035 (120 by 2030) through a mix of repurposed estate and new builds funded by public capital and public‑private partnerships, with early waves focused on areas of highest deprivation. 

Alongside this, the neighbourhood health workforce will evolve, with existing staff working in more integrated, multidisciplinary ways and new roles emerging to support proactive, preventative, personalised care. 

ICBs will shape local configurations of neighbourhood health, supported nationally through reforms to funding flows, incentives for prevention and community‑based care, and new financial mechanisms that enable neighbourhoods to scale innovative models that improve outcomes and deliver value for money.

Next steps

DHSC and NHSE will set the baselines for ICBs to proceed with new arrangements. Over the coming months a model neighbourhood health centre (NHC) definition will be published, including archetypes for service provision and estate utilisation. Alongside this new GP access targets will be published, with the development of new payment approaches that support the left shift and a series of modern service frameworks on the core conditions to give ICBs the baseline they need to inform future commissioning. 

Key actions for members

The framework’s plans will be delivered in two stages to run in parallel: 

Stage 1: Immediate foundational actions for 2026-27 

ICBs must ensure delivery of basic neighbourhood health foundations while beginning joint planning with HWBs and partners. There are a number of key requirements:

Reducing hospital demand

• Develop an initial plan to reduce non-elective admissions and bed days through expanded urgent care, rehabilitation and reablement at neighbourhood level, informed by risk register analysis.

Improving general practice access

• Agree plans to tackle unwarranted variation and improve GP access.
• Ensure GP practices meet core hours and new urgent access requirements set out in the GMS contract.

Establishing neighbourhood structures

• Agree neighbourhood footprints aligned to natural communities for future INT development.
• Plan to establish integrated neighbourhood teams (INTs) focused on high-priority cohorts, including exploring devolved care budgets.

Elective care reform

• Begin planning a neighbourhood-based elective pathway, clarifying how neighbourhood models will support RTT standards and use devolved outpatient commissioning budgets.

Reducing community health waiting times

• Confirm plans to meet 18‑week community waits and eliminate 52‑week waits.

Funding and partnership requirements

• Confirm how ICBs and local authorities will use pooled Better Care Fund (BCF) resources in line with national guidance.
• Continue improving the primary–secondary care interface using the Red Tape Challenge.
• Confirm organisational ownership of deliverables.

Data and evaluation

• Set out plans for robust data‑sharing arrangements to support patient identification, monitoring and evaluation.

Oversight

• Regional NHS teams will work with ICBs to monitor implementation of these essential actions.

Stage 2: Longer-term reform (April 2027 – March 2029)

ICBs, HWBs and local partners must develop a locally owned neighbourhood health plan that underpins fundamental reform and starts delivering national objectives.

Requirements for the Neighbourhood Health Plan: 

• Describe how the three national reform agendas will be delivered locally.
• Explain how neighbourhood health will support wider local goals, including reducing health inequalities and contributing to broader public service reform.
• Show how local objectives are informed by the JSNA and other relevant assessments.
• Confirm final neighbourhood geographies for delivery.
• Set out organisational responsibilities, including who delivers what.
• Define governance and operational partnership arrangements.
• Show how neighbourhood health aligns with other local initiatives (e.g. Best Start Family Hubs, mental health hubs, housing, Pride in Place, employment support).

Integration with NHS commissioning:

• Once agreed, this plan must be incorporated into the ICB’s refreshed five‑year strategic commissioning plan, becoming the formal NHS commissioning strategy for neighbourhood health.
• Systems are encouraged to go beyond minimum expectations, including expanding prevention and wider neighbourhood health functions.

Analysis  

The Neighbourhood Health Framework represents a strategic statement of intent from the government and responds to our members calls for clarity on vision and ambition following the publication of the 10 Year Health Plan. While the ambitions outlined are not fundamentally new, the framework provides a clearer articulation of how national direction, local flexibility and system accountability are expected to align. Its publication therefore marks an important moment following the 10 Year Health Plan, outlining specific expectations for ICBs and partners while signalling a welcome permissive approach that acknowledges the lessons of previous attempts at reform. 

Moving to a neighbourhood model of care must mean resetting the relationship between the NHS, the wider public sector and communities. The framework, alongside wider neighbourhood initiatives across government, re-affirms the intention to shift the way in which power and resources are distributed. 

A key strength of the framework is its explicit recognition that transformation requires a shift in relationships as much as in service models. The emphasis on co-design with communities, shared local outcomes, and a stronger role for HWBs demonstrates an understanding that neighbourhood health cannot be delivered solely through NHS structures. The requirement for HWBs to lead the development of locally owned outcome measures could, if implemented well, anchor neighbourhood health in genuinely place-based priorities rather than centrally defined metrics.

However, this approach comes with risks. Striking the right balance between national minimum expectations and local discretion will depend on the strength of local partnerships and the ability of systems to work collaboratively. This is particularly important given the current challenges faced by ICBs which will impact their ability to effectively drive forward this agenda.

In areas where relationships are less mature or stretched there is a danger that neighbourhood planning becomes fragmented, or too focused on NHS priorities and operational pressures. The framing of neighbourhood health as delivering ‘core targets’ - which would be set and overseen by DHSC – risks reinforcing this tension.

The framework’s three reform agendas - routine access, proactive care and alternatives to hospital - are broadly aligned with the direction of policy travel outlined in the Medium Term Planning Framework. The focus on strengthening general practice, scaling integrated neighbourhood teams, and expanding virtual wards and urgent community response echoes past commitments. However, these are yet to be fully backed up by changes to financial or regulatory policy, and this raises questions about what will be different this time. Limited local convening and improvement capacity within ICB primary care teams is likely to make some of these aspirations challenging, particularly in areas that are further behind in developing their primary care infrastructure. There is a risk that areas already performing well will continue to advance and strengthen general practice capabilities, while others may fall further behind without targeted intervention to build this much‑needed infrastructure within primary care. Given the stretching targets set on same-day clinically urgent requests, it’s vital that we see additional support for ICB primary care teams to provide the support required to smaller practices. 

The decision not to define nationally what constitutes an INT is encouragingly permissive, but will require mature, capable partnership working within systems to avoid duplication and ensure clear accountability. The success of INTs will rely on local agreements to create robust governance, information sharing and delegated budgets; many systems continue to face barriers in these areas.

The framework itself provides welcome detail on how the new population health delivery contracts (SNP, MNP, IHO) relate to one another, setting an expectation that IHO contract holders – where they exist – will subcontract neighbourhood services, including through MNPs. However, the language is sometimes inconsistent, implying that IHOs are standalone organisations rather than the population-based contractual model described in the blueprint.

The new national goals and metrics introduce additional complexity. While the intention to set clearer, more measurable ambitions is understandable, many of the targets - such as reductions in non-elective activity for priority cohorts or the 90 per cent urgent GP access requirement - represent significant performance shifts at a time when workforce and demand pressures remain acute. There is also a lack of consistency on which cohorts are defined as ‘high priority’. Without corresponding investment in community capacity, diagnostics, social care, VCSE organisations and digital infrastructure, these ambitions may risk becoming deficits-driven rather than transformation-driven.

Establishing a neighbourhood health service will require a shift in resources away from hospital-based care into preventative services. This framework does not set out how this will take place in reality. Until there is a substantive policy in place to support this shift, the long-running tensions between recovery and reform will continue to play out. The focus on demand-reduction within the UEC pathway, for example, is welcome, but does not set out how the role of ambulance trusts can evolve as part of the shift to neighbourhood working.

Finally, the scale of cultural change required cannot be underestimated. Neighbourhood working necessitates significant behavioural shifts, including sharing power and decision-making, new ways of working across professional boundaries, and the realignment of organisational identity. These are deep cultural changes that require long-term investment in leadership and organisational development, not short-term structural adjustments.

Overall, the framework provides a more structured and actionable articulation of the government’s ambitions for neighbourhood health. It signals a recognition that national reform must be rooted in local systems, relationships and community insight. The challenge for ICBs and HWBs will be to translate this permissive framework into genuine change, maintaining focus on the long term and building neighbourhood models that improve outcomes, reduce inequalities and deliver genuinely integrated, person-centred care. The next three years will be critical: while the direction is clear, success will depend on consistent local leadership, cohesive partnership working, and investing in prevention and community-level capacity at scale.

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