The government’s 10 Year Health Plan for England: Fit for the Future proposes the creation of a neighbourhood health centre in every community. The accompanying Neighbourhood Health Framework and recent describes the ambition to develop “a neighbourhood health service”, building on a wide range of earlier initiatives across the NHS, local government and the wider health and care system. Yet the idea that healthcare should be organised around communities is far from new.
Community-based provision has a long history in the UK. Early examples stretch back to the nineteenth century, including community hospitals in South Wales and the pioneering Peckham Health Centre in London. Local health clinics were also discussed during the formation of the NHS in the 1940s.
However, it was not until the 1980s that national policy began seriously to consider shifting from hospital-centred treatment towards community-based models that emphasised prevention alongside care despite numerous community-based or place-focused developments existing long before this.
Several approaches emerged over the following decades. In the 1980s, the Community Care Centre model aimed to bridge the gap between home and acute hospitals. The Lambeth Community Care Centre (1985), for example, provided 24-hour nursing and rehabilitative care in a domestic environment rather than an institutional hospital setting. In 1986 the Cumberlege report recommended neighbourhoods of between 10,000 and 25,000 while in Hampshire in the 1980s services focused on populations of between a few hundred to 47,000 people. Around the same time, the Bromley-by-Bow Centre (1984) pioneered what later became known as the Healthy Living Centre model, combining health services with wider social and community support. These ideas influenced developments in the 1990s, including Health Action Zones designed to tackle health inequalities, often to include local partnership groups.
The 1990s also saw experimentation with the polyclinic model, which integrated specialist services traditionally delivered through hospital outpatient departments such as the Idle Medical Centre (1994) in Bradford. Community care was further developed into the Intermediate Care Centre model, such as the Pulross Centre in Brixton (2000), designed to support rehabilitation and reduce hospital admissions.
Lord Darzi’s 2007 review of healthcare in London revived the polyclinic concept within a broader “polysystem” model. In practice, this produced a mix of polyclinics and networked services layered onto existing hospital and primary care structures. Evaluations later suggested that local commissioners struggled to organise these networks effectively within existing policy frameworks and estate constraints. Many of these initiatives faded from national policy after 2010, although newer integration programmes followed, including the Vanguard programme and the Primary Care Home model. As with earlier initiatives, these approaches were gradually absorbed into subsequent policy shifts or sustained only where strong local leadership existed.
Against this backdrop, the latest proposal for neighbourhood health centres appears less a radical departure than another iteration of a long-standing ambition to shift care closer to home. The main difference lies in scale. The NHS Ten Year Plan envisaged neighbourhood services with multi-disciplinary teams covering populations of 30,000 to 50,000 people – roughly the size of the city of Canterbury, although the Neighbourhood Health Framework leaves the exact size to be determined locally. Yet the concept of “neighbourhood” itself is far from straightforward. In urban planning, a neighbourhood is usually understood as a distinct local area with recognisable boundaries and identity. By contrast, census neighbourhood units typically contain between 400 and 1,200 households, or roughly 1,000 to 3,000 people. The government’s proposed scale therefore bears little resemblance to how neighbourhoods are commonly understood in spatial or social terms. Within the NHS the concept of neighbourhood will also sit within current delivery structures for community health and social care services, place-based care and primary care network (PCN) footprints. From the earliest developments of neighbourhood public services, bureaucratic neighbourhoods tended to be significantly larger than what is locally seen as meaningful.
Concepts such as neighbourhood and community are also inherently complex. Scholars have identified more than 140 different definitions of “community”. “Neighbourhood” likewise carries geographical, social and psychological meanings, often intertwined. In policy terms, the word often functions less as a precise description of place and more as a framework for organising services and coordinating resources. What policymakers describe as a neighbourhood may not correspond to how residents themselves understand their local communities.
The Neighbourhood Health Framework proposes a delivery model built around integrated neighbourhood services operating across primary care, community health, mental health, social care and voluntary sector provision. Current guidance places considerable emphasis on multidisciplinary neighbourhood teams, proactive care coordination, home-first rehabilitation, population health management and shared digital systems designed to support care closer to home. In this sense, the model is not simply about creating a physical health centre in every community, but about developing integrated systems of neighbourhood-level care delivery, sometimes supported by physical hubs.
The framework also refers to potential organisational approaches including single neighbourhood providers, multi-neighbourhood providers and integrated health organisations. Currently these are presented more as possible commissioning and contractual arrangements than as a definitive restructuring of NHS provision. Existing GP contracts and hospital standard contracts are expected to remain in place, at least for the foreseeable future.
The assumption behind this approach is that greater integration can be achieved through neighbourhood-based service delivery. Yet the policy still rests on two concepts – integration and neighbourhood – that remain deliberately broad and flexible. Both function as policy umbrellas encompassing a wide range of initiatives, from multidisciplinary team working and virtual wards to digital integration and proactive population health management. This concept was further reinforced in recent NHS England guidance on Neighbourhood Health Centres, which described them as “planned as part of an asset-based neighbourhood model, connected to wider networks of support, health promotion and community activity, rather than as stand-alone clinical facilities”. Previous approaches such as the Vanguard Programme and London “polysystems” produced mixed results in terms of both impact and sustainability, and there remains limited evidence that such models can consistently achieve their intended policy goals.
Practical challenges also remain. The government has proposed building or upgrading around 250 neighbourhood health centres by 2035 to provide “one-stop” locations for GP, community and social services (DHSC March 2026). The financial implications are considerable. Estimates suggest annual running costs of around £2.4 million per centre, with capital costs potentially exceeding £20 million where new buildings are required.
Another unresolved issue concerns the role of general practice. While existing GP contracts are expected to remain unchanged, practices will be expected to work more closely within neighbourhood arrangements. PCNs may evolve further as neighbourhood delivery structures develop, yet their current population sizes vary considerably. Some serve fewer than 30,000 people, while others cover more than 75,000, making any standardised national model difficult to implement and also issues in local implementation.
Taken together, these challenges highlight the tension between ambitious policy design and the realities of existing organisational structures, estates and workforce constraints. As with previous place-based initiatives, the most likely outcome may be a patchwork of locally adapted models with different degrees of service integration. Service development also needs to adopt an approach broader than just health and social care. As the recent report of the Independent Commission on Neighbourhoods notes single issue approaches to neighbourhoods often fails and needs to be lined to other issues such as education, employment and lack of social infrastructure. Innovation will undoubtedly occur as local leaders adapt policy ideas to local circumstances. But whether neighbourhood health will deliver the transformation promised remains uncertain. More likely, we will see a proliferation of locally varied initiatives labelled as neighbourhood services – the latest chapter in a long history of attempts to bring healthcare closer to the communities it serves.