The Government’s newly published neighbourhood health framework sets out its plan to establish integrated neighbourhood working as the operating model for the NHS and its partners. It reflects the shift from integrated care system level working to place-based implementation, with neighbourhoods becoming the primary unit of delivery typically serving populations of 30,000-50,000.
Alongside the framework, the Government released Fit for the future: Towards population health delivery models requiring Integrated Care Boards to begin implementing within the next three years outcomes-based contracts, with a view to Integrated Health Organisation (IHO) contracts becoming the norm. It also details the new neighbourhood contracts – Multi Neighbourhood Provider and Single Neighbourhood Provider with a consultation expected later in the year on the contracts.
This article explores the new neighbourhood health framework, examining its potential impact on organisational structures and contractual agreements in the years ahead.
The framework provides a structured blueprint for systems to act now - setting clear national goals, and outlining the minimum interventions required of ICBs over the next three years.
At its core, the framework sets out four overarching aims of neighbourhood health – and they are to:
- Improve people’s health outcomes, reduce health inequalities and help them stay well at home.
- Organise services around the person, with more convenient, personalised, and joined-up care.
- Reduce pressure on acute services – hospitals and care homes.
- Cut waste and duplication.
The framework rightly highlights that achieving these aims “hinges on the NHS, Local Authorities and partners transforming how they work together”. It will be for those parties to agree a joint vision and redesign commissioning and delivery at neighbourhood level, with the support of the new Multidisciplinary Integrated Neighbourhood Teams.
The framework sets out a series of minimum nationally set “goals, objectives and metrics”. These will be supplemented by locally set goals that will be determined based on local need and established by Health and Wellbeing Boards, ICBs and Local Authorities (with the input of other partners). Together, these form a national minimum expectation that all ICBs must meet from 2026–2029:
- Improving health outcomes for high priority cohorts such as people with frailty, care home residents and those with long term conditions.
- Improving access to general practice, including faster, more reliable same day access.
- Enhancing planned care and cancer care, ensuring smoother experiences and better coordination.
- Improving urgent and emergency care, particularly through alternatives to hospital based provision.
- Boosting patient and staff satisfaction, recognising the workforce is central to transformation.
ICBs are required to implement a minimum set of interventions across three reform priorities: improving routine healthcare, strengthening proactive care, and expanding alternatives to hospital based services.
Here are a few examples of the interventions that help bring the reforms into focus:
- Implementing electronic patient records systems – and direct prescribing to community
- Roll out of AI and ambient voice technology
- Strengthening the role of pharmacists
- ICBs to maintain and develop women’s health hubs
- Increasing the capacity of virtual wards
- Exploring better alternatives to mental health hospitals
The framework makes it clear that there will be some significant shifts in contracting and commissioning.
These contracts will cover the whole population health budget for a geographically defined population, with responsibility for resource allocation, service planning, and moving services into the community. Only NHS Trusts with IHO status can hold them, though mature neighbourhoods may “lead” an IHO through joint ventures. IHOs will be given delegated commissioning responsibility for primary care services.
We know that two foundation trusts have been identified to hold IHO contracts and they are Northumbria Healthcare and Northamptonshire Healthcare. While IHO will be statutory organisations, they will be able to form joint ventures and alliances with independent sector GP providers.
Further guidance on IHOs will follow together with details of an IHO implementation programme. According to NHS confederation the national teams are considering routes for non-NHS organisations, including primary care at sale organisations to hold an IHO contract.
These contracts will cover multiple neighbourhoods, serving 250,000 patients with a group of providers. Providers will be required to collaborate both with Trusts and single neighbourhood providers, sharing risks and responsibilities. It remains to be seen the types of entities eligible to hold Multi Neighbourhood Contracts are likely to be flexible and may include Trusts, single providers, or groups such as GP Federations.
SNCs will deliver services within individual neighbourhoods, typically covering populations of 50,000, where these services are not included in core GP contracts (GMS, PMS, or APMS). Contract holders will be expected to collaborate closely with local GP practices. Although subject to further consultation, it is highly likely that Primary Care Networks (PCNs) - or at least the infrastructure established around PCNs – will evolve into Single Neighbourhood Providers, serving as the vehicle through which SNCs are held and delivered.
Perhaps the most visible component of reform is the commitment to deliver 250 Neighbourhood Health Centres (NHCs) by 2035, with 120 expected by 2030. These centres are intended to become the “place to go for most health needs” - a one stop hub bringing together GPs, community teams, social care, diagnostics and voluntary sector support.
Crucially, the estate model is mixed:
- 20% of new builds will be funded from public capital
- Others will leverage public private partnerships, marking a renewed role for private finance in community infrastructure
- The first wave (2026/27) prioritises repurposing existing NHS estate (mostly NHS Property Services and LIFT properties) in areas of highest deprivation.
This phased approach acknowledges the challenges of the current estate while enabling progress.
The framework places significant emphasis on the role of data and digital tools in enabling integrated care. Alongside this, the neighbourhood health workforce will evolve working in a more integrated, multidisciplinary way. There is no mention of when we can expect the NHS workforce plan.
Implementation will occur in two overlapping stages:
- Stage 1 for 2026/27: Immediate changes, including agreeing neighbourhood footprints, establishing governance arrangements, aligning with estates guidance, and confirming intentions to use pooled funding.
- Stage 2 for April 2027–March 2029: Building on progress to develop full Neighbourhood Health Plans through Health and Wellbeing Boards and ICBs.
This staged approach recognises that systems are at different levels of maturity and that building neighbourhood health is an incremental journey requiring sustained partnership.
We can support organisations whether ICBs, NHS providers, VSCE partners and independent sector partners to scale neighbourhood working.
Our multidisciplinary teams can support across the full neighbourhood journey and on a range of issues:
- Governance and partnerships
- Commissioning, contracts and procurement
- Data, digital and information governance
- Workforce and organisational change
- Estates and infrastructure
Please contact Rob Day if you’d like to discuss any of the issues discussed here.
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