Understanding the New Neighbourhood Health Service & The Big Community Implementation Challenge.

The Neighbourhood Health Service represents a vital shift toward local, integrated, and preventative healthcare. With the goal to deliver care directly within communities, it promises a future where health services are not only more accessible, but more personalised and effective. Why have we failed to implement this vision before? Are the latest plans more ‘do to’ than ‘do with’? How can we can learn to overcome our past mistakes and build momentum for change?

What Is The Neighbourhood Health Service?

​The Neighbourhood Health Service, is the exciting plan to focus on integrating care in our local communities. Each neighbourhood is intended to be 30-50000 people. It aims to transform healthcare in communities by focusing on local, integrated care. Tailored to meet the needs of specific communities. This approach seeks to provide care closer to people’s homes, so they stay healthy and outside of hospital. It emphasises prevention, and utilising digital solutions to enhance service delivery. ​

The plans were described by NHS England’s Neighbourhood Health Guidelines for 2025/26 . Setting out an initial vision for the Neighbourhood Health Service to inform local healthcare systems of the steps they are expected to take this year. It has been said that more details will be included in the upcoming NHS 10 Year plan.

Key components of the Neighbourhood Health Service include:​

• Integrated Neighbourhood Teams (INTs): Multidisciplinary teams comprising health and social care professionals working together in collaboratition to address the diverse needs of the community.​
• Enhanced Access to Care: Improving access to general practice and urgent care services to prevent unnecessary hospital admissions. ​Local Democracy and Health
• Focus on Prevention: Shifting from treatment to prevention by promoting health literacy, supporting early intervention, and reducing health deterioration. ​
• Digital Integration: Leveraging digital infrastructure and solutions to improve care coordination and patient engagement. ​NHS England

The key vision is to bring together all parts of the health and care system to collaborate together, including primary care, social care, community health, mental health, acute services, and a wider a range of partners, with the shared purpose of meeting people’s needs more effectively.  The goal is to create healthier communities, enhance patient experiences, and increase individuals’ agency in managing their own care.

Why Do We Need a Neighbourhood Health Service?

We need a neighbourhood health service because the current way of delivering healthcare is failing badly our NHS has been described as broken. Whilst our communities are struggling with physical and mental health problems; with 40% of UK adults aged 16 and over reported having at least one long-term health condition (NHS Digital). At the same time our hospitals are getting up to 96% full in peak times (BBC) They can’t get much busier. It is also hard to get help with a 1/3rd of patients thinking they are waiting too long to see a GP (NHS GP Survey),

Care That is Closer To Home

Too often, care feels distant, disconnected, from the people who want to get help, and only kicks in once someone is already seriously unwell. A neighbourhood health service helps by bringing healthcare closer to home, right into communities where people live. Instead of waiting for issues to escalate, it focuses on preventing illness and spotting problems early, when they’re easier to sort out.

Connecting Care

Traditionally healthcare takes place in a bubble. Whereas the neighbourhood health service is about making things more connected: Bringing together GPs, nurses, mental health professionals, social care, health coaches, pharmacists and local support teams and local authorities, so they actually talk to each other. This means fewer mixed messages, quicker responses, and care that’s personal, not just clinical.

Community Led Healthcare

The neighbourhood approach is intended to encourage people to get involved in their own health and the health of their community, using digital tools, local support, and better access to services when needed. In other words, it’s healthcare that gives support in the community friendly, connected, and focused on keeping people healthy rather than just treating them when they’re ill. This is why, at it’s best it is ‘do with’ where what the service does is cocreated with the community.

Hierarchy of Social Intervention and Community.

The Hierarchy of Social Intervention shows that when community care is lacking it puts pressure to create expensive poorly targeted interventions. Putting huge pressure on charities, first response services (ambulances and police), hospitals and care homes when there is not enough community support for people’s health needs. Neighbourhood Health at its best can be seen as an attempt to regrow the community health and care support that can give us the best support where we live and takes pressure off expensive less targeted interventions at a different level in the system.

Most Diseases Are Social

In healthcare we tend to individualise healthcare. But in reality so much of our healthcare problems are transmitted socially. Poor lifestyles, lack of exercise obesity and smoking as well as mental health problems have all been shown to be socially transmitted. Whereas social isolation has also been shown to be linked with bad healthcare outcomes. These issues don’t exist in a vacuum: they’re influenced by our surroundings, social norms, and the communities we live in.

The potential for neighbourhood community health is that many of the activities that improve our health are also social in nature. 

•  Engaging in sports with others.
•  Preparing a meal together.
•  Singing, dancing,
•  Discussing our problems.

It’s human nature to normalise behaviour based on those around us. That’s why pressuring people to change their habits rarely works. 

The Big Opportunity for the NHS?

The big opportunity for the NHS is to go beyond the traditional ‘walls’ of the health service that keep people out through a series of appointments, assessments and waiting lists. This is an opportunity to go out into the heart of communities where people are getting sick and help to manage and improve their help.

It has the potential to transform the NHS from a hideously outdated 20th century industrial health system, to a system that engages and enables people to live healthier lives throughout our communities. The test of the success of these plans is whether communities and our society really do engage with them. To do that these neighbourhood health services need to be ‘done with’ and not ‘done to’ communities.

Neighbourhood Community Health a Long Term Vision

Quotes Describing A Vision Neighbourhood Health:

“break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally, but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.

“groups of GPs to combine with nurses, other community health services, hospital specialists, and perhaps mental health and social care services to create integrated out of hospital care.”

These quotes and many others are particularly interesting as they are NOT from the latest plan but actually from the 2014 NHS Five Year Forward View. (It is worth reading the old plan as it is startling how we are talking about much the same things today)

A Vision For Neighbourhoods Worth Repeating

When reading the 2025 vision in the Neighbourhood health guidelines 2025/26 , it is hard for most people with experience of such plans in the NHS not to not get a weird feeling of deja vu. These have also been described in a similar version outlined before as well as the Five Year Forward View i could have quoted the NHS Long Term Plan (2019) the Fuller Stocktake Report in (2022). 

From Vision to Reality

It is an inspiring vision with evidence to match from elsewhere in the world, but we’ve now had 11 years of quoting more or less the same vision. Not quite up to the delay in implementing  ‘prioritising prevention, that has been a declared focus in every NHS plan since the 1960’s’.

But implementation has clearly been a massive problem for community health plans. So there is a difference between having a plan and reality. (Surely a big lesson for the upcoming 10 year plan) So what is the current plan for implementing the neighbourhood health service?

Implementing the Neighbourhood Health Service

The Key Components of Neighbourhood Health Services (according to NHS England)?

The actual details of the plan to introduce the Neighbourhood Health Service will be announced as part of the NHS 10 year plan. However, the  Neighbourhood Health Guidelines for 2025/26 were released in January so that local systems could get prepared this year. This produced by the previous version of NHS England which has also had it’s board replaced, and the real implementation plan will be in the 10 Year Plan. So it is officially half baked…it certainly could do with a lot more time in the oven….or better simply given to local services to bake their own Neighbour Community Cakes. 

The Six Core Components (According The the Neighbourhood Health Guidelines:

The Neighbourhood Health Service Documents identified six core components of a successful service based:

1. Population Health Management: 

Using data to understand and address the health needs of local populations. 

Comments:

The NHS has excellent data on population health. Unfortunately, it also has a very poor track record of using it well. Communities can help better understand and support meeting the needs of the population. This excellent report by the Health Foundation extensively details the problems of population health data and identifies solutions.

2. Modernise General Practice: 

Improving access to services and streamlining the patient journey.  

Comments:

Whilst the pressure on GPs is immense. They are extraordinarily busy and often short of staff. Asking them to also take on running Neighbourhood Health Services requires them to multitask in a really extraordinary way. It requires an entirely different skill set and that can’t be underestimated. I’m sure that some will relish the challenge and thrive. But many are ill placed to take on this additional challenge (to put it mildly). 

It most likely that GPs are best placed to lead these services in some places, but not in others. Making the GP the default centre of the neighbourhood creates a single point of failure in implementation. It may be wise to look at a number of alternative options.

There may be many unintended consequences of centring community health at GPs. It may mean that people just extend the GP role meaning that the centres focus only on treating poor health, rather than prevention

The ‘inverse care law’ means those that live in the high deprivation areas have the least resourced care. (This was coined 50 years ago and is shamefully still the case). Whilst many in disadvantaged communities dislike going to their GPs and that could be a substantial barrier, as well as those are also the places that frequently have the most struggling practices. (Nuffield Trust)

3. Standardising Community Health Services: 

Ensuring consistent, high-quality care based on local needs. 

Comments:

The main benefit of community health services is their role in adapting to the complex needs of local people and communities. Standardising the approach is precisely the wrong thing to do. An approach in a rural well off area will not work in a diverse inner city. (As shown by this research). Standardising the approach goes completely against the idea of ‘doing with’ not ‘doing to’. You simply can’t do coproduction and standardisation. So this creates lots of contradictions in terms of implementation.

“A personalised care approach means ‘what matters to me, not what’s the matter with me’”

Fuller Stocktake Report 2022

4. Neighbourhood Multidisciplinary Teams (MDTs): 

Bringing together health, social care, and voluntary sector professionals to provide coordinated care. 

Comments:

Building strong MDTs as well as Integrated Neighbourhood Teams, are the core of neighbourhood health that we need to build around. Having a diversity of expertise is central to the effectiveness of these services. There must be a core of permanently employed staff to enable this. This creates a solid structure that more adaptive community services can be built. If there is no solid core; With partnership services each being fully committed to supporting the service providing only part time or seconded staff, it will create a wobbly unreliable service.

Integrated Intermediate Care with a ‘Home First’ Approach: 

Providing rehabilitation and reablement services to help people return home or avoid hospital admission.  

Comments:

Yes of course in principle we want people to receive the best of care as close to the home as possible. As this improves patient experience and recovery. However, we need to be careful that the purpose of the community services don’t’ become a dumping ground for hospitals. Flooded by people who are too sick to stay at home but are too well for hospitals. It should also be noted that physios, are absolutely essential to rehabilitation and reablement and there is a significant shortage of qualified staff in these roles. With the number of people waiting for physiotherapy increasing by 27% in 2 years. (Guardian)

6. Urgent Neighbourhood Services: 

Standardising and scaling urgent care services in the community, with a single point of access.  

Comments:

Again standardising is completely the wrong word here. Responsive would be a far more accurate description. The point is that people are able to access the right care they need as fast as possible. It is about connecting the system up, but what the patient needs are, will vary, as will the appropriate response. Having a standardised system that doesn’t work will result in failure demand. Again we should not be standardising something we have not created yet. We need to build standardisation AFTER we have learned what works in practice NOT before.

If you you want to start or manage a community group or a community project please read my guide here or get in touch.

Why the Neighbourhood Health Service Implementation Could Go Wrong From The Start?

One of the biggest errors, in the Neighbourhood Health Plan is the instructions for local systems to prepare for implemention. These are:

• standardising 6 core components of existing practice to achieve greater consistency of approach (see above)
• bringing together the different components into an integrated service offer to improve coordination and quality of care, with a focus on people with the most complex needs
• scaling up to enable more widespread adoption
• rigorously evaluating the impact of these actions, ways of working and enablers both in terms of outcomes for local people and effective use of public money

Why Implementing Neighbourhood Health Services Through Standardisation Is An Error

This is an error running community services is absolutely not like running a hospital or a factory. We don’t need standardised processes to be scaled up and rigorously evaluated. (Ironic given the NHS England’s own challenges of evaluation of community health schemes.). The whole point of community work with complex patients is adapting to meet their unique needs. They are complex needs precisely because they don’t fit into existing processes. We can’t optimise for complexity. Taking a standardised approach is completely missing the point. 

Integration Community Health Has to Mean Integration

It is important to mention that integration is not a top down process where someone is in charge ordering everyone around. Integration means there are multiple organisations working in collaboration and harmony to improve the wellbeing of people with health needs.

These needs may involve health such as the 2.8million people unable to work due to poor health, but also incorporate the whole range of other social economic and physical circumstances that people live in. The true test is not whether someone is in charge. The test is whether these organisations can properly collaborate together, without fighting for money or control.

Do Neighbourhood Health Services Actually Work?

We can understand whether the Neighbourhood Health Services work as similar schemes were actually implemented by the Vanguard plan in a limited number of places. An evaluation revealed they were somewhat successful, they experienced slower growth in emergency admissions, 1.2-2.6% growth compared to 4.9% increase national and a very modest decrease in hospital bed days. (HSJ) That being said if prevention was the goal the 12 month period evaluated was far too short a time to reflect that. That being said if prevention was the goal the 12 month period evaluated was far too short a time to reflect that. 

Long-Term Evaluation of the Integrated Care Transformation

There was a long term 6 year evaluation of the impact of the mid-Nottinghamshire care transformation conducted by the Health Foundation. Although the nature of the scheme changed over time there was 4.3% reduction in A&E attendances and a 6.8% reduction in hospital admissions as well as reductions in length of stay in hospital.

Evaluating Whether They Are a Good Investment?

The evaluations of such schemes show progress but, it would need to be replicated at large scale effectively to make a significant difference in costs. It should be seen in the context this year alone local providers are being asked to make an unlikely 4% improvement in productivity. Whilst it is of vital help. The current schemes would not be enough to ‘fix the NHS’ if the goal is reduce hospital costs. That is unless we can get them to work much more effectively than the current models.

Problems With Evaluating Community Health Models.

The process of evaluation of community health schemes is deeply problematic. Evaluating such a complex model is a bit of a fool’s errand as there are simply too many variables. Scientists work in labs because they want to reduce all the different variables to the on thing they want to test. This is in no way possible in a community setting. Every member of the community staff member every disease and countless other factors are all sources of variation.

What Does the Evaluation Mean?

Even if you could evaluate community health programmes with 100% accuracy, there is simply no way of knowing if you were to replicate the exact same model in another area whether it would have the same effect and why. It is quite likely many healthcare systems will waste a lot of resource evaluating these programmes as accurately as possible, but with no real conclusions. It is far better to track broad measure of health and harm and correct the implementation based on feedback.

Good Health and Care is What Counts in Community Health.

In reality it is simply good care that matters in community health. It is the right thing to do if it’s the fastest and most effective way to keep people healthy. I do understand that there will be NHS chiefs saying the whole point is to reduce admissions to hospital. But that can be illusionary progress. If someone does not go to the hospital when they should, that may be avoiding admission, but it’s not good care. There is also the problem that if you are successful and more frail people alive and living at home for longer, eventually admissions will increase again, as the number of overall frail patients increase.

Prevention Has To Be a Core Goal of the Neighbourhood Health Scheme.

If the Neighbourhood Health Schemes focus on treating poor health and not prevention, then what will simply happen is that we will get ever more sick people. This will increase health costs whatever we do as the health of our communities continue to deteriorate. Sadly, the Neighbourhood Health Guidelines seem to suggest that the ONLY real goal is to prevent hospital admissions. This is a terrible mistake MUST be directly addressed in the 10 year plan. 

The community health schemes are overwhelming the best place from which to coordinate interventions to prevent ill health in the first place. They have the knowledge and relationships and local understanding. In my view this should be their number one priority and raison d’être because they could do prevention more effectively than any other part of the health system.

Innovation and Test and Learn in the Neighbourhood Health Service

The Neighbourhood Health Service could and should be leading the way in health innovation. With their close relations between actors and speed of work they are also the perfect environment for the new ‘test and learn’ initiatives. They can provide safe spaces, to ensure there is clinical oversight.

Neighbourhood health services will be perfectly well placed to partner with local businesses, charities social enterprises, tech firms, and personalised support such as health coaches; bringing them together with carers, community groups those in need managing long term conditions and preventing poor health. They could be the perfect innovation space for the NHS and the place to engage the wider community. So the NHS should not just see them as places to do care but places of innovation and the perfect environment for test and learn initiatives.

Speed of Innovation in Communities

The pace and spread of technological change will mean new tech especially based on AI will soon be in the palms of people in the community at an ever increasing rate. It won’t be long that people in the community have far more detailed information about their health than their GPs and hospitals. The community space is the perfect space to surf that wave of change without having to adapt the massive expensive core systems of the NHS. The communities are the perfect place for cocreation, testing and piloting new healthcare solutions at pace.

The NHS Neighbourhood Guidelines and Innovation

Of course the neighbourhood health guidelines do not mention their potential for innovation. It should be noted this is my own opinion about evaluation innovation and prevention. The actual NHS guidelines do not say any of this as to be frank the people who wrote it don’t clearly don’t have a scooby-doo. But that does not mean that there won’t be opportunities masses of opportunities as local areas implement the schemes. We may also learn much more when the 10 year plan refreshes this approach. But the key thing is that the community neighbourhood health services really get going. We can improve their effectiveness only if there implementation actually works.

What Can We Learn From Past Attempts to Implement Integrated Community Health?

What Held the Vanguard Neighbourhood Schemes Back?

Why were the community neighbourhood health schemes not more successful in the past? According to a report by the BMJ:  budget siloing and lack of collaborative working between providers and short term contracts as well as delays in funding were very problematic. These are all very familiar problems to those of us who have worked on initiatives between providers in the NHS. The previous attempts to create an internal market for the NHS were deeply damaging for collaboration and cooperation between providers, It makes the early reports that there are attempts to revitalise the internal market extremely concerning. (Times).

ICBs and Neighbourhood Funding?

The local Integrated Care Boards (ICBs) are essential to specifically to provide leadership and direction to sort all these problems out in future. The NIHR conducted a review of integrated working and found “the need for a formal body at Place level with a clear remit for commissioning integrated services.” 

Local Leadership is Required for Neighbourhood Integration

What’s that? The ICBs have just been told they have been cut by 50%? Mr Streeting seems to be making a big mistake if we serious about these transformations. The problems of investing properly in communities and integrated care MUST be directly addressed in the new 10 year plan. Having a clear and specific and ‘ring fenced’ plan for coordinating these services and making sure they play nicely together will be essential for success. Without ringfencing these community schemes with the complexity may find them trapped in the spiral of control and power of others.

Sharing Neighbourhood Health Service Budgets

The key component of success is in experience of Canterbury New Zealand was having ‘One System One Budget’. I’ve previously called it rewriggling funding: where pools of funding allow locals to dip in and thrive, rather than simply flowing through. If you can control your own budgets, you can coordinate and focus on what’s right for people. It is also much cheaper as services stop fighting over resources and focus on fixing patient problems. If there is one wish i could have from the 10 year plan and the government is give local neighbourhoods fixed and protected budgets. In particular budgets protected from hospitals. As others use their budgets to manipulate and control.

What is the Budget for the Neighbourhood Health Service?

The elephant in the room at the moment is there is NO budget for Neighbourhood Health Service. There does not appear to be spare cash in local authorities or the NHS or anywhere else. It may fall to the Better Care Fund (A weird money pot shared between the two). But that is already used mostly for social care, so redeploying that would be robbing a homeless Peter to pay an invisible Paul.

If neighbourhoods are dependent on others for their funding it could become a system warped by the demand of their stakeholders. Directly undermining the ability of the community to function. The worst possible scenario is that they are funding directly by the hierarchical, autocratic, hospital trusts who are all about ‘do to’. Putting the needs of hospitals in direct conflict with the ‘do with’ needs of their communities.

“….a ‘top-down’ approach of driving change and improvements risks alienating the workforce and communities and hinders development of trusting relationships”

Fuller ‘Stocktake” Report 2022

Community Health Is Worth Investing In.

If the goal is to give power to communities then the communities need to control their own funding. But who or how it gets there is a mystery right now. Without funding any talk of implementation is just pie in the sky. But communities and the people with in are not just costs. They create the most precious of human value. If public services can’t invest in community then we need to have a conversation with our politicians about accountability. It is OUR NHS after all. 

If you have your own community group and want to get funding please read my guide here or get in touch.

‘Do With’ Or ‘Do To’ Community Health?

So are the NHS England’s Neighbourhood Health Guidelines for 2025/26, ‘Do With’ or ‘Do To’? I would argue that not only the plans clearly not written to ‘Do With’ they are not even ‘Do To’ either. They are much closer to ‘Do At’ Neighbourhood communities. It talks about engaging with local communities it is only the most surface deep politically correct thing to do.

It is little more about a performance in front of communities. There is nothing about building the relationships the shared sense of belonging and purpose that are the hallmarks of community work. As described there is no reason for communities to engage with this work at all, other than see it as another form of treatment provision. Merely renaming the GP practice as ‘neighbourhood health centre’, everything else is performance pretending to do community, whilst what the NHS does remains little changed.

Creating Local Communities For a Healthier Future.

Local leader DO have a choice. It does not have to be a performance of community. They can implement these plans alongside genuine deep community work. Engaging and enhancing existing community groups and projects. Doing community care with their communities. Whilst also connecting people in new ways, creating dedicated local initiatives, founding around genuine expert health advice.

They can act as health innovation hubs testing and new technologies and ways of working with local businesses charities, universities colleges and 3rd sector organisations. So let’s use the opportunity to build health communities where we can all be a part in to create a healthier society and a healthier NHS.

Conclusion:

The Neighbourhood Health Service offers a compelling vision of local, integrated, preventative care, bringing healthcare directly into communities. However, turning this vision into reality means learning from past failures, To truly succeed, we must embrace genuine collaboration, prioritise local innovation, create secure and stable independent budgets and replace outdated top down approaches with meaningful, community led solutions. The path forward is clear: less ‘doing to,’ more ‘doing with’ Our communities is essential for addressing the health problems running rampant through our society.