Policy briefing: Neighbourhood Health Framework

What has been announced?

The Department of Health and Social Care has published its Neighbourhood Heath Framework (17 March 2026). Within this document the Government sets out how it intends to design care around patients and to implement the ‘left shift’ – moving care out of hospital into the community – that was outlined in the 10-Year Health Plan in 2025.

The framework covers the following areas, which we describe in more detail below:

• Five core aims 
• National and local goals 
• Reform agenda 
• Going further in other services 
• Single and multi-neighbourhood providers 
• Integrated Health Organisations  
• Neighbourhood health estates, locations and workforce 
• Neighbourhood health finances. 

Five core aims

The framework contains five core aims:

1. Improve outcomes and reduce health inequalities – through prevention, proactive care management, stronger primary/community services, and finding better ways to work between hospital specialists, public health, adult and children’s social care and the voluntary care sector.
2. Organise services around the person, utilising a strong digital approach and improving access to care, moving more outpatient care from hospitals into neighbourhoods, improving continuity of care, and more effectively coordinating for complex needs.
3. Reduce pressure on acute services including hospitals and care homes using neighbourhood working to decrease avoidable hospital admissions, reduce the impact that prolonged hospital stays have on patients (‘reconditioning’), reduce avoidable care home admissions, and ensure acute services are focused on those who need them most.
4. Cut waste and duplication by integrating services across health and local government and wider partners, by making better use of digital options and ensuring the NHS is more sustainable. 
5. Help the NHS deliver against core targets to ensure patients get a better service overall and that their rights under the NHS constitution are honoured.

National and local goals 

Measuring the overall success of neighbourhood health will be achieved via a series of national and local goals.

Goal 1: Improve health outcomes  

By focusing on several 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 to be delivered by March 2029 are:

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

Goal 2: Improve access to general practice

• Ensure that 90% of clinically urgent patients are seen the same day by March 2027
• Routine GP access and satisfaction will be baselined in 2026–27 with local goals set by ICBs in the interim.

Goal 3: Improve experience of planned care

• Achieve a 25% diversion of referrals via single points of access (SPOA) for 10 high‑volume specialties by March 2027, supporting waiting list recovery
• Ensure a 10% 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 to be delivered by March 2029:

• Reduce the non-elective admissions and emergency department (ED) attendances for several high-priority cohorts (these are defined as severe frailty, in a care home or housebound and end of life) 
• Contribute towards ensuring that 82% of ED patients are seen within four-hours by March 2027, and that in the longer term that rises to 85%
• Reduce category 3 (urgent) and 4 (less urgent) ambulance calls that arrive at hospital for frail adults in care homes or who are housebound by expanding the urgent care response
• Improve discharge efficiency by reducing delays in discharging patients.

Goal 5: Improve patient and staff satisfaction

From 2026-27:

• Introduce new patient reported experience measures (PREMs) and patient reported outcome measures (PROMs) with an ambition to ensure year‑on‑year improvement
• 95% of people with complex needs to have an agreed care plan by 2027
• Introduce new staff experience measures in neighbourhoods with annual improvement trajectories.

Through health and wellbeing boards (HWBs), ICBs and local authorities will:

• Agree how neighbourhood health can deliver measurable benefits and how they will change over time
• Address local priorities and health inequalities identified by a local joint strategic needs assessment (JSNA)
• Consider outcomes from local outcomes framework metrics, and other outcomes across health and wellbeing, adult social care and ‘Best Start in Life’
• Consider adult social care priorities such as ensuring people can remain in their own homes as they age and reduce care home admissions.

These aims will be delivered in combination between ICBs and local authorities working with other local partners. ICBs are charged with ensuring a minimum set of interventions over the next three years; these will act as the building block for further local priorities.

Reform agenda

The reform agenda covers three areas:

1: Improve services for people who need routine healthcare, so neighbourhood health benefits everyone

Support GP access recovery by:

• Using new national GP access targets to improve access
• Incentivise proactive management of population health
• Increase the use of digital tools such as AI triage, online consultations and ambient voice technology
• Reviewing community diagnostic centres (CDC) capacity with a plan to increase this capacity over the next three years
• Via the ‘Red tape challenge’ reduce bureaucracy for GPs and improve connectivity between GPs and secondary care. This will be achieved by using GIRFT guidance, new electronic patient records (EPRs) and access to shared care records, direct prescribing to pharmacy and improving standards medication information
• Improving out-of-hours GP services
• Strengthen pharmacists’ roles in delivering care, recognising pharmacies as one of the most accessible parts of primary care.

2: Improve proactive care for people

Integrated neighbourhood teams (INTs) will bring together different professions and partners to work side by side to support people. The NHS will not create a national definition of what should constitute an INT.

NHS England will ask ICBs to ensure the initial focus of INTs is people with frailty, those in need of end-of-life care, people with multiple long term, conditions such as cardiovascular disease (CVD) and diabetes, children and young people, people living with cancer. ICBs will be able to go further and faster setting up INTs for other conditions that have been identified by HWBs.

NHS England will also produce a best practice guide for NHS frailty pathways and maintain and develop access to women’s health services and women’s health hubs. ICBs will also be expected to grow core community services and work with providers to reduce waiting times.

In addition, there will be an expectation that there will be an end to outpatient care as we know it and that data sharing between neighbourhood health services and hospitals will be standardised.

3: Deliver better alternatives to hospital care

Urgent community response services will be expanded, and virtual wards will be utilised more to avoid people going to hospital when it isn’t necessary.

By working with local authorities and other patrons, intermediate care capacity will be increased by making best use of community beds and expanding home-based care. Alternatives to mental health hospitals will be explored.

Going further in other services

Local systems will be supported by the National Neighbourhood Health Implementation Programme so that they can build capacity and capability. Then over the next three years, it will be considered how other services can effectively contribute to neighbourhoods, including community pharmacy, dental services and optometry.

ICBs in conjunction with local authorities will jointly plan and align neighbourhood plans with JSNAs, HWBs and the Ministry of Housing, Communities and Local Government (MHCLG).

The framework makes it clear that care will continue to be delivered by those who know communities best, but there will be a change to how services are commissioned and contracted, with an aim to remove barriers to integration, which it reports the NHS and councils have been aware of for a long time.

The aims will be to focus on outcomes with ICBs tasked with ensuring that neighbourhood health is the default for NHS care provision. To achieve this ICBs must work with local commissioners of social care and public health services, as well as private, civil society and VCSE sectors.

Neighbourhoods are not single areas, and the framework suggests that in many cases they won’t need to be. The way care is organised will be for ICBs and local authorities to work through. Neighbourhoods need to be organised around populations with a need to join up resources and form partnerships to hold contracts.

DHSC and NHS England will provide an enabling, non-prescriptive approach, which will allow local systems to determine optimum models. Local areas will want to consider the footprint of INTs and how they relate to local authority boundaries.

For the NHS, ICBs will set clear expectations and contract accordingly. DHSC and NHS England will not dictate how these contracts will be delivered and by whom, but hospital standard contracts and general medical service contracts will remain the primary mechanisms for delivery for the two biggest groups of NHS providers.

Single and multi-neighbourhood providers (SNPs and MNPs)

Single neighbourhood providers (SNPs) will deliver new services through integrated neighbourhood teams within a defined single neighbourhood. SNPs will allow primary care to take on services not currently commissioned through existing general practice contracts. NHS England will consult further on how SNP contract holders will collaborate with each other.

Multi-neighbourhood providers (MNPs) will coordinate consistent delivery of services across multiple neighbourhoods and have a clear relationship with SNPs and GP practices. They will use their scale to design and co-ordinate the neighbourhood health service and may deliver services at a larger scale than a neighbourhood. It is anticipated that an MNP will serve a population of around 250,000 and an SNP will serve a population of around 50,000, however there will be no national mandate on the size of neighbourhood health geographies. This will mean that contracts will be commissioned at a scale that ICBs believe to be appropriate for their area. The exact size and shape of the of neighbourhoods will be agreed between local authorities and HWBs.

Integrated Health Organisations (IHOs)

IHO contracts give providers a whole population’s health budget for a population within a set geography. IHO contractors will have responsibility for resource allocation and service planning across the whole pathway. IHO holders will be required to ensure the needs of the population are met, within the available resource and budget. The IHO contract holder will develop ways to shift care away from the acute sector into community settings. The population served by an IHO contract should share a border with one or more MNP to align delivery for that population and enable commissioners to apply consistent outcomes.

NHS trusts will be deemed as able to hold IHO contracts based on decisions by DHSC and NHS England. Trusts deemed as eligible will have provided an assurance they have the skills and capability to work in partnership with others across the system and to manage the risk of holding subcontracts with others. Those trusts initially chosen will be high performing and capable advanced foundation trusts. These trusts will be commissioned by ICBs using a newly developed IHO contract. IHO contracts will only ever be held by NHS organisations.

Across primary care in GP, pharmacy, dentistry and optometry, these services will continue to be commissioned in line with national contracts. ICBs will delegate their commissioning responsibilities in this regard to the IHO, where an IHO has been agreed and formed.

There will also be consultation on how MNPs, SNPs, General Medical Contracts and Primary Care Network Directed Enhanced Service (PCN DES) will work together, and how PCNs might become SNPs in the future.

The IHO, MNP and SNP are all population-based contracts. The ICB will contract a single IHO for an area, the IHO will then contract several MNPs. Each MNP will work with multiple SNPs, and each SNP will work with all the GP practices in the neighbourhood.

Neighbourhood health estates, locations and workforce

The 10-Year Health Plan promised that services would be local, digital, in a patient’s home if possible, and if not, in a Neighbourhood Health Centre (NHC), and only in hospital when necessary.

NHCs will be seen as the place to go for most health and wider needs in every community and there is a plan to have 250 NHCs by 2035, with 120 of those ready by 2030.

Initially existing staff will be expected to work differently, with consultants working more closely with GP and community health services. GPs will work more closely with integrated neighbourhood teams with district nurses and others. The full details of what the NHS workforce will look like will become more apparent as the NHS publishes the 10-Year-Workforce Plan.

Neighbourhood health finances

The financial framework from 2026 to 2027 financial year will be amended to change block contracts and payment flows. In parallel, financial mechanisms will be developed to support the establishment and scaling of neighbourhood health. A permissive approach will be taken, and new payment methods or alternative contractual approaches will be embraced if they have credible plans underpinning them.

What do we say

When the 10-Year Health Plan was launched last year, one of our criticisms was that it was light on detail about how this system would work and that it was essential to quickly publish additional details.

This framework, at least in part, provides that additional information and direction. The areas of priority are clearer and there is more detail on how the new structures will fit together. This document reiterates the move towards a more permissive local delivery of care – care that was historically delivered within a hospital setting. The three areas within the reform agenda are uncontentious, improving access for people who require routine care, improving proactive care and providing better alternatives to hospital. All are positive steps. Alongside these areas of reform, the goals for the system are sensible, and are as to be expected of anyone attempting to fix a healthcare system that is beset with the challenges the NHS faces.

However, it is apparent that when the Government talks of moving care delivery towards primary care, what is meant is ‘primary medical care’. The framework makes it clear that community pharmacy, dental services, optometry and other services are not, largely, included in the initial priorities, with a vague commitment to look at how these can contribute to neighbourhoods in the “next few years”.

We say this is a huge opportunity missed. Primary care providers are the first port of call for people needing healthcare – in other words, the front door to the NHS – and they bring care to every neighbourhood. It’s where the public go for advice, treatment, or referrals to more specialised care if it is needed. And it’s where ongoing relationships with healthcare providers are built, ensuring continuity of care. The framework is also specifically a missed opportunity to utilise optometry; a professional sector that uniquely has the people, premises and equipment to have a significant impact on NHS healthcare delivery, if funded and utilised effectively.

Our view is that the lack of a concrete timeline in the framework to use the wider primary care is both of deep concern and adds weight to the argument that all primary care providers remain undervalued and underutilised. As we have previously flagged, primary care has once again been narrowed to mean GP-led care, despite each of the core pillars of primary care offering significant value and benefit in achieving the Government’s ambition of achieving a ‘left shift’.

An objective look at the priorities that have been set out in the framework highlights this failure. For example, it is well-established that good eyesight helps to reduce falls, something we addressed in work “Transforming eye care for older people for better health”.

While good vision alone will not meet the 10% reduction that is called for, our view is that it could make an important and cost-effective contribution.

Similarly, we say that optometry can help with the aim to ensure people are able to see their GP more quickly for urgent care. We can do this by ensuring that patients do not present to their GP for an eye problem but instead can go to an optometrist, releasing much needed capacity for GPs. In our position statement on changes to the human medicine regulations, we set out that over 1.5 million prescriptions are issued every year by GPs for eye related medications. We say that these patients could and should be seen in optometry, where the required skills and equipment are ubiquitously found. In a similar way, targets to improve urgent and emergency care performance can benefit from utilising optometry-led services.

Turning to the structural changes, we have further concerns. The new mechanisms of IHOs, MNPs and SNPs are likely to occupy significant resource within currently stretched ICBs. IHOs, despite being responsible for local health delivery via a left shift, will we argue be dominated by foundation trusts. The initial focus on GP services is in part understandable; these services are under significant pressure, and the public are concerned about access. But, given the limited resources the NHS has at its disposal and the fact that optometry, dentistry and community pharmacy are not part of the initial wave of priorities, our concern is that by the time attention turns to primary care providers, the new ways of working will already be established. This may mean, as so often before, that the wider primary care professions are an afterthought; their potential is untapped and wasted. In our view, this isn’t what was meant by a “left shift”, nor is it we would contend what Lord Darzi envisaged when he reported on the state of the NHS in September 2024.

Darzi was clear: what we have now and what has gone before it hasn’t worked. He concluded that it’s time for the NHS to try something different, and that meant utilising and funding the whole of the primary care system.

In our view, if the framework is a missed opportunity for utilising primary care, it also fails to seize the opportunity to transform eye care and eye health. Optometry-led services, despite chronic underfunding, are not beset with the issues facing other parts of the NHS. Workforce and access to those services have been resilient, with the profession finding ever more innovative ways to ensure the service provided to patients does not suffer. Arguably, this innovation and resilience has often been to the sector’s detriment when it comes to funding, with the NHS well aware of, but unwilling to tackle, the pressures facing optometry because it is not struggling as much as peer professions.

The focus on NHCs, building 250 of these by 2035, may help tackle some of the structural problems faced by GPs, but in terms of primary eye care they are unnecessary.

Optometry-led services have the potential to help the NHS tackle the challenges it faces, but to do so the profession must be enabled to do so. Unfortunately, clear direction from the centre is lacking. The framework indicates that the optometry must once again look to secondary measures where it can demonstrate value to the wider system. Of these, there are many to point to, including: improving access to GPs; meeting targets on 18-week waits; and reducing NHS red tape, waste and inefficiency. These are all areas we can support or have ideas that can help.

However, it bears repeating that these important measures of impact are secondary to our core skills – in other words, optometry is ready to support, but the benefits are marginal. The true change that is needed for eye care and eye health in England, and the change that will improve the patient experience of eye care and prevent avoidable irreversible sight loss, is transforming access to primary eye care services. Optometry-led care is uniquely placed and qualified to deliver this aim. The framework fails to enable optometry to press on with this essential goal; it says that primary eye care has to wait.

We say that this is not good enough. The public deserves better. And the solutions needed to ensure the public feel and see the difference are simple to implement. Which is why we repeat our call on the Government to issue guidance to ensure that every patient has access to a range of services that can be delivered in primary eye care. Services that are safe, cost effective, free-up much needed NHS capacity in other areas, and most importantly provide patients with reassurance and a better experience and outcome.