The neighbourhood model is at the centre of current NHS policy. Neighbourhoods formed a central theme at June's NHS ConfedExpo conference, and the UK Government has launched a consultation on the proposed contracting model to support neighbourhood health services.
More than a month into Andy Burnham's premiership, neighbourhood health remains one of the clearest signals of the Government's direction of travel. His longstanding commitment to devolution and place-based public services has reinforced the view that neighbourhoods will be expected to move from policy ambition into delivery reality. That matters because neighbourhood health is no longer just an NHS service-design concept. It is becoming a test of whether Whitehall, ICBs, providers, councils and industry can shift from national intent to local execution.
What is a neighbourhood?
A neighbourhood is not simply a smaller geography, a GP network, or a building. NHS England’s latest contracting consultation describes it as a local area where services are organised around a defined population (often around 50,000 people, although footprints may vary) with ICBs, local authorities, civil society and wider public services aligning through integrated neighbourhood teams. They should not be conflated with any community-based initiative: the real distinction is integrated, multidisciplinary care around a population, not merely moving activity into the community.
This is why the relationship with PCNs matters. Single Neighbourhood Providers look like an evolution from PCNs, while Multi-Neighbourhood Providers operate at greater scale (NHS England’s working assumption is roughly 250,000 people or more, though not nationally mandated1). If neighbourhoods end up replacing PCNs, with SNPs delivering enhanced GP services, leading local neighbourhood teams and coordinating non-NHS support, that would be a material shift: from collaboration by goodwill to collaboration through contract.
What impact should they have?
At their best, neighbourhoods should reduce avoidable hospital demand, improve access, support people with complex needs earlier, tackle inequalities and make care feel joined up. The Government framework sets goals around health outcomes, GP access, planned care, urgent and emergency care, and patient and staff satisfaction.
But the deeper impact should be financial and behavioural, and seen beyond healthcare, through improved pathways, digital enablement, return to work, social mobility and wider system outcomes. If neighbourhoods cannot show value beyond the walls of the NHS, they will remain pilots with good stories but limited scale.
What is needed to make them operate well?
Three things: contractual form, permission to shift money and data
The NHS has had integrated teams, local partnerships and community initiatives for years. What is new is the possibility of contractual frameworks, governance, accountability and financial flows that make integrated working real. NHS England’s consultation is explicit that local commissioners will define and fund much of the content locally, with no new national funding for these contracts2. That creates flexibility, but also risk. If the same overstretched money is simply rebadged, neighbourhoods will inherit the NHS’s structural tension rather than solve it. Neighbourhoods need to find ways to shift funds locally so that money follows the patients.
The greatest risk is that neighbourhoods change organisational structures without changing behaviours, incentives or accountability. If that happens, they will simply replicate many of the challenges that have limited previous integration initiatives.
Data is the final enabler, and perhaps the hardest test of whether neighbourhoods can become genuinely population based. The NHS still struggles to link its own data across primary care, community services and hospitals; linking that with social care, local authority and wider community data is harder still. But without it, neighbourhoods will struggle to identify people at risk, understand the interaction between clinical need, social need and wider determinants, or target support before people reach crisis point. Linked data must therefore be tied to pathway redesign, local insight and practical intervention, not treated as another dashboard. This will reveal how benefits accrue across primary care, hospitals, social care, local government, patients and carers.
Kent and Medway’s early neighbourhood contract3 illustrates the opportunity and the challenge. A portion of primary care income (£10m) is being linked to A&E attendances, with funding contingent on outcomes for complex patients. That is exactly the sort of incentive the system needs to treat patients out of hospital. But it also shows how difficult this will be: outcomes-based neighbourhood funding requires trust, analytics, leadership and a willingness to pool resources.
Ultimately, neighbourhoods are workforce models as much as they are contracting models. Success will depend on whether local teams are given the capacity, skills and incentives to work differently.
What role can industry play?
Industry should treat the NHS as a partner and start with one question: “what local problem can we help solve?” The direction is away from national messaging and local sales push, and toward place-based co-delivery, local evidence and practical operating-model support. Partners will be judged less on novelty and more on whether they can help solve concrete neighbourhood problems under financial constraint.
That means helping neighbourhoods prove value in practice: redesigning pathways, building implementation capability, enabling analytics and workforce change, and generating evidence. Real-world evidence should show wider societal impact, not just clinical outcomes.
Industry will also need to proactively support the establishment of share care models for conditions that have historically been managed in the hospital setting and help build the case for associated movement of funds.
This will require broader coalitions across ICBs, places, PCNs, community trusts, social care, councils, community anchors and VCSE organisations.
Will neighbourhoods influence uptake of new medicines?
Yes, but not as a silver bullet. Neighbourhoods may influence uptake where medicines depend on earlier identification, proactive care, community monitoring, shared protocols or new pathway capacity. But they will not magically overcome affordability, acute-provider incentives or local variation.
For life sciences, the implication is sharper segmentation. Some geographies will have mature neighbourhood capabilities; others will not. Launch and access strategies will need to reflect local readiness, not assume uniform national adoption.
Final words
Since NHS ConfedExpo, the conversation has matured. The question is no longer whether neighbourhoods matter, but whether systems are willing to change incentives, deploy resources differently and integrate health and social care at a scale that makes prevention real.
The neighbourhood agenda will succeed only if it becomes more than rhetoric. The Government's early focus on devolution, neighbourhood delivery and the relationship between health and social care has only increased the importance of getting neighbourhood models right. NHS England may create the contracts and ICBs and local authorities may set the strategy, but neighbourhoods will only matter when money, data, accountability and delivery capability move together across health and social care. That is where industry, and IQVIA, should focus.