Neighbourhood health framework: clarity, gaps and what comes next

Overview

The government has published its much-awaited Neighbourhood Health Framework. It sets out in new detail what neighbourhood health aims to do and how this will be achieved, building on the 10 Year Health Plan, the Neighbourhood health guidelines 2025/26 and the Medium Term Planning Framework. 

The framework describes neighbourhood health as putting the person at the centre of how local services are organised and delivered – including GP and community services, urgent care and outpatients, as well as services commissioned by local authorities such as social care and public health.  

The new guidance brings some long-awaited clarity to commissioners and providers about what neighbourhood health should deliver. There is much to welcome. But questions remain around whether targets can ease pressures on the acute sector as well as improve patient care and experience; whether focus can be maintained on long term population health priorities among a plethora of specific shorter term delivery goals; whether permissiveness in designing local services and rigid structures can coexist; and, fundamentally, whether integrated care boards (ICBs) and other organisations have the capacity to action it all. 

Below, our experts set out their more detailed analysis of the framework. They consider the parts to celebrate, the aspects that raise some concerns, what’s missing, and the questions that remain outstanding.  

A clearer vision for reform – or still unclear?  

'Questions remain about the longer-term direction of reform and how the different elements fit together.' – Anna Charles

Anna Charles

Senior Fellow

For some time, we at The King’s Fund have observed that neighbourhood health is used to describe a wide range of ideas and approaches to delivering health and care. It means different things to different people and in different places. Despite it being well over a year since the government first set out its ambition to ‘create a neighbourhood health service’ – and this being positioned at the heart of the NHS 10 Year Plan – uncertainty remains about where this agenda is expected to lead. Against that backdrop, does this new framework provide the clarity that has been missing? 

There is much to welcome. Some had feared the framework would take a narrow view, focused only on NHS priorities such as GP access or clinical care for people with the highest needs. While these feature prominently, the framework also gives weight to improving neighbourhood health in a broader sense, setting clear expectations for the NHS, local authorities and other partners to work together around locally defined priorities. 

It also brings greater clarity to governance, giving health and wellbeing boards a clearer role in shaping and overseeing neighbourhood health. While it does not confer new formal powers (nor could or should it given this is NHS guidance), it positions them as key forums for convening and joint priority setting, helping to anchor neighbourhood working in place and population health. The challenge will be whether this role is matched by sufficient influence and capacity to deliver. 

The guidance also usefully distinguishes between aspects of neighbourhood health (such as access) where national NHS direction and standardised outcomes make sense and those that require the NHS to act as a partner alongside others, where a more locally led approach is essential. 

Overall, while the framework offers welcome clarity on early priorities and avoids an overly NHS centric lens, questions remain about the longer-term direction of reform and how the different elements fit together. This clarity of vision is particularly needed at a time when the local leaders tasked with delivering it are overstretched and facing significant disruption through local reorganisations.  

Do systems have the capability to deliver?

'...To practically deliver it, and to stitch this framework together with the wider flood of related frameworks and guidance... It is an awful lot to do...' – David Buck

David Buck

Senior Fellow, Public Health and Inequalities

My immediate response to this framework was not about the specifics within it, but about the impact and capability of the systems and people within them to respond, to practically deliver it, and to stitch this framework together with the wider flood of related frameworks and guidance such as population health commissioning and delivery models. It is an awful lot to do, especially when commissioning, analytical and change management skills are in short supply, and morale is rock bottom for many of those still left and expected to ‘do it’. 

Beyond that is the growing worry that the NHS is at huge risk of turning in on itself again, as the bandwidth needed to focus on external partnerships on population health – and work towards the government’s goal to halve the healthy life expectancy gap – will be drowned in the coming wave of establishing and implementing new NHS organisational forms. 

In that context it is welcome that health and wellbeing boards seem to be in the frame once again having been largely relegated to the sidelines for so long, and it is good to see the mention of wider government policy in this framework. But there is not yet a convincing strategic story of how the government sees all of this coming together. The contrast with Scotland’s population health framework and its implementation is stark. It shares similar goals but is being delivered without major organisational change, supported by a strong central reform narrative that binds the key players in the NHS and beyond tightly together in terms of direction, joint outcomes and accountabilities.

In short, while there are now a growing list of ingredients on the table, the recipe remains unclear. And with systems bruised, reforming and short on capacity and capability, leadership attention will be consumed by internal NHS rejigging.

Where social care is – and isn’t – included

'If social care is to genuinely play a full role, will be it properly funded to do it? ' – Simon Bottery

Simon Bottery

Senior Fellow, Social Care

The immediate reaction from a social care perspective is relief. There were concerns that the document would be heavily focused on the NHS and have little to say about social care. That hasn’t happened. There are a decent number of references to social care, care homes and care providers, and these feel integral to the document and coherent within it, rather than tacked on for show. The emphasis on the role of local authorities and, particularly, health and wellbeing boards is also welcome. The commitment to grow reablement capacity is important.   

All this makes sense when you look at some of the priority groups discussed: people with frailty, care home residents, housebound patients, those receiving end of life care, people with dementia. If the framework didn’t acknowledge the role of social care in supporting these groups it would be very strange indeed.   

There are gaps. It is disappointing that learning disability is not a priority, given the poor health outcomes for that group. There is no specific mention of home care, even though you could not get deeper into the heart of people’s neighbourhoods than their living rooms. Care providers are mentioned only as continuing to deliver services rather than in helping to plan it.   

There are also, inevitably, questions about resources and capacity. Are health and wellbeing boards and – particularly at the moment - ICBs really equipped to take on the roles ascribed to them? If social care is to genuinely play a full role, will be it properly funded to do it?   

There is also a fundamental question left unanswered because it is too big for the framework: how do you wrap support around in-need individuals, many of whom – unlike the NHS – are not entitled to publicly-funded social care?   

Still, social care will feel the framework is something it can – and indeed must – work with.   

A framework still driven by hospital priorities, not primary care 

'Ultimately, success will depend on the unglamorous fundamentals of capacity, data, and clear accountability, none of which can be delivered without primary care expertise at the table.'  – Beccy Baird

Beccy Baird

Senior Fellow

In many ways the framework holds few surprises. It focuses on conditions where proactive neighbourhood care can improve patient outcomes, together with a clear intent to move specialist support into the community. Yet despite being a framework for neighbourhood care, it remains dominated by hospital-driven priorities such as emergency admissions, outpatient referrals and A&E attendance. As a result, it still feels heavily shaped by secondary care performance pressures rather than the realities of delivering primary care at neighbourhood level.  

The targets – of 10% reduction in non-elective admissions and bed days for high-priority cohorts (including people with frailty, housebound patients and care home residents) by March 2029, and a 25% diversion rate via single point of access and multidisciplinary team model for at least 10 specialties by March 2027 – risk shifting the responsibility for managing secondary care pressures onto general practice rather than genuinely improving care for patients.   

Most ICBs lack the workforce, specialist skills or headspace to lead this work in a meaningful way. This is compounded by the sharp reduction in clinical leadership capacity within many ICBs, including the widespread loss of GP-specific leadership roles. Without that embedded expertise, it is hard to see who will provide the practical primary care input needed to design neighbourhood models that are workable, sustainable, and grounded in everyday general practice. Ultimately, success will depend on the unglamorous fundamentals of capacity, data, and clear accountability, none of which can be delivered without primary care expertise at the table.  

The proposals on estates, particularly the repurposing of existing NHS Property Services and LIFT buildings, could help unlock much-needed community based infrastructure. But this will only work if the longstanding issues that have led to these buildings being underused are genuinely resolved.  

Finally, while the framework acknowledges that wider primary care services should be included in future phases, community pharmacy, dental services and optometry are notably absent or light on detail. Even if ICBs are permitted to go further, it is difficult to see how they would do so when they already lack the capacity and skills required.  

Three models in one framework – how will it fit together?  

‘This approach reflects a desire among some at national level to ensure that the different delivery models fit together neatly, in a broadly consistent way across the country. This fixed view of the endpoint stands in contrast with the approach to implementation, which is more permissive and experimental. ' – Chris Naylor

Chris Naylor

Senior Fellow

As part of the government’s neighbourhood health agenda, the NHS and other organisations are being asked to come together in several new ways with the goal of providing more integrated, community-based services. The new forms of provision include:  

• Single neighbourhood providers (SNPs)  

• Multi-neighbourhood providers (MNPs)  

• Integrated health organisations (IHOs)  

Since the publication of the 10 Year Health Plan, it has become clear that these are not necessarily intended to be brand new organisations, so much as new contractual vehicles through which existing organisations – including GP practices, NHS trusts and others – can work together more closely.   

But how will these three new models fit together? The current thinking on this is set out in the neighbourhood health framework with further detail in an accompanying document on population health delivery models:    

• Every ICB will be expected to award a whole population budget to one or more IHO, such that IHOs ultimately cover the entire population of England.  

• IHOs will then subcontract to MNPs, SNPs and other providers (including trusts) to deliver services.  

• The geographical boundaries of SNPs, MNPs and IHOs should all be coterminous so they are nested within each other.  

This approach reflects a desire among some at national level to ensure that the different delivery models fit together neatly, in a broadly consistent way across the country. This fixed view of the endpoint stands in contrast with the approach to implementation, which is more permissive and experimental.   

It is hard to see how the permissive approach to implementation will lead ultimately to the neat, consistent endpoint described above. In principle, it may be possible to take different routes to the same destination, but there’s a deeper tension here between different philosophies towards reform, with what you could call a ‘rationalist’ approach (preferring neat and tidy plans) pitched against a willingness to see more local experimentation. As long as that tension at national level remains unresolved, I fear that navigating it will prove challenging for the people leading neighbourhood health in local systems.  

Neighbourhood health needs cross-government alignment 

National teams shaping the next phase of neighbourhood health should spend as much time working with their counterparts across government as they do with local systems and communities.' – Ruth Robertson

Ruth Robertson

Senior Fellow

I read this framework in my first week on secondment to the Greater Manchester Combined Authority Prevention Demonstrator, so my take might not surprise you. I found it hard to focus on the framework itself without lifting my eyes to look side to side and upwards. For me, understanding the potential of a policy like this is not just about examining the document itself. It is about considering how wider government policies will help or hinder what this framework is trying to achieve. 

Looking side to side, the framework starts by noting most people want to access health and care close to home. But what most people really want is to stay healthy and avoid needing those services at all. A critical success factor for the neighbourhood health service will be how well it connects to other services across the public, private and VCSE sectors to support a person unable to work due to ill health, a child missing school because of mental health issues, or someone facing multiple challenges, including time in prison, addiction, homelessness and chronic health conditions. 

It is positive that the framework recognises neighbourhood health as a joint endeavour and asks health and wellbeing boards to consider wider public service reform when developing their neighbourhood plans. But to do this meaningfully, the 16 wider government initiatives listed need to become a core part of the discussion. Modern strategic commissioning should seek to understand need and align services across the whole public sector and beyond. 

Looking up, success will depend as much on coordinated planning across national government as on coordinated planning in neighbourhoods, to ensure national policy helps rather than hinders this work. That means aligning different departments’ approaches to neighbourhood geographies, accountability and performance frameworks, funding and workforce planning; and helping local areas to put in place the infrastructure – such as datasets that span public services – needed to make that possible. National teams shaping the next phase of neighbourhood health should spend as much time working with their counterparts across government as they do with local systems and communities.