Neighbourhood Health: Delivering Integration or Another Layer of Fragmentation?

We are hearing a lot about Neighbourhood health as central to future of community-based care in England and a core principle in the NHS 10 Year plan. But what does it mean in practice, and how is this different how to we achieve more joined up local care that doesn't further fragment services? Will this model address inequalities?

I have this week explored what neighbourhood health is, how its development has evolved, what is now planned, how it aligns with the ten-year plan and its three major shifts, some of the main risks to success such as funding, estates, accountability and workforce, and why digital capability and digital equity will ultimately determine whether the model succeeds.

Neighbourhood Health is more than a reconfiguration of services; it is a shift in how we understand place, population, need, and the relationships that make health systems function.

More than an administrative function, they are communities and geographies that people recognise, where social ties and local identity shape how individuals experience their care and support. Neighbourhoods are defined populations aligned with real communities, typically around 50,000 people but with geography taking precedence over population size.. Building care around these geographies is an attempt to make the system more coherent, more relational, and more capable of responding to local needs and aligned with local authorities, voluntary and community organisations, and the lived experience of communities themselves.

Within each neighbourhood sits an integrated neighbourhood team comprising individuals from general practice, community health, social care, mental health services, secondary care specialists and voluntary sector partners. These teams work collectively around a shared population and shared outcomes aiming to overcome traditional organisational boundaries and create conditions where care is genuinely coordinated. In practice, neighbourhoods tend to include both place-based multidisciplinary teams and "teams of teams", such as frailty teams, mental health teams or end-of-life teams, which cluster around specific patient cohorts.

This is not simply about colocation but integration: shared goals, combined expertise, common care plans where appropriate, and a focus on anticipatory and proactive care rather than reactive activity. Neighbourhoods aim to reduce avoidable hospital use, shift care upstream and tailor support to individuals in more personalised ways. They also provide the platform for more ambitious long-term work on prevention, patient activation and the wider determinants of health.

The aspiration to shift care closer to home is not new. References to "moving care into the community" appear in policy documents dating back decades.

Every integrated care system has some examples of neighbourhood-level integration. Many earlier initiatives, such as integrated care pilots, the Vanguard programme, attempted to build versions of neighbourhood-based models. There are further examples that include community matrons, community services working as shared teams, specialist consultants embedded into community-based pathways such as consultant geriatricians working within community frailty services. Some regions already operate neighbourhood health centres that bring different services together under a single roof. These examples demonstrate the feasibility of neighbourhood health and have demonstrated they can deliver a better experience for patients and greater job satisfaction for staff.

Many of these examples have largely remained isolated pilots, operating without the infrastructure or system conditions required for wider adoption. Barriers in information governance, digital interoperability and estates made it difficult for teams to coordinate effectively or expand their reach. At the same time, resources could not be easily shifted from acute to community settings, limiting the ability of neighbourhood models to demonstrate their full value. Workforce shortages across general practice, nursing and social care added further pressure. Together, these constraints meant that while local pilots frequently succeeded on their own terms, the wider system struggled to translate into sustained, population-level transformation. Which meant they failed to scale.

The current iteration is designed to tackle the barriers that kept earlier neighbourhood models as isolated pilots. The intention is to build neighbourhood health consistently across England, supported by national policy alignment, investment in neighbourhood health centres and payment and contractual mechanisms that enable population-based commissioning. The focus is on establishing core foundations now, with a view to expanding into broader population health over time.

Neighbourhood health centres are central to this approach. By colocating teams and making best use of existing estate, they aim to strengthen collaboration and create a more coherent experience for patients. Improving access to general practice sits alongside this. With increasing use of online routes to request care, neighbourhood teams are positioned to connect access, triage and proactive management more effectively.

The model prioritises anticipatory, personalised support for high-priority cohorts such as people with frailty, care home residents, housebound individuals and those nearing the end of life, who account for a significant share of avoidable hospital use. Expanded urgent community response and hospital-at-home capacity are intended to prevent unnecessary admissions and support people safely at home. In parallel, outpatient pathways are being redesigned so neighbourhood teams and specialists can reduce unnecessary hospital attendances through local diagnostics, advice and guidance and shared-care arrangements.

Neighbourhood health is central to delivering the NHS ten-year plan because it embodies the plan's three major shifts: prevention, community-based care and digital transformation. By organising teams around defined populations, neighbourhoods create the foundations for anticipatory and preventive care, identifying risk earlier and connecting clinical care with community resources, shifting resources from hospital-centred delivery to integrated, local models, enabling more care to be provided closer to home.

Digital capability is fundamental to neighbourhood health because it is the infrastructure that allows teams to function as one system around a shared population. Neighbourhood models rely on interoperable records, shared care plans, digital access routes, remote monitoring where appropriate and population-health tools that identify risk earlier. These capabilities enable real-time coordination and personalised, proactive care at scale; without them, the model cannot deliver the integration, prevention or community-based working envisioned in the ten-year plan. But digital transformation also brings well-documented risks. If inclusion, accessibility and digital confidence are not prioritised, the very tools that enable neighbourhood working can deepen inequality and exclude those already at the margins. Neighbourhood health will only succeed if digital pathways are designed not simply to modernise services, but to widen participation and reduce avoidable disadvantage.

Digital exclusion remains a significant risk for neighbourhood health. UK evidence consistently shows that digital skills, connectivity and device access vary by age, income, disability, migration status and housing stability, with the people most likely to experience poor health also facing the greatest digital barriers. Neighbourhood models rely on registered lists and system-held data, yet groups such as people experiencing homelessness, asylum seekers or those in temporary accommodation are often under-represented, making them less visible in population planning. Trust is another factor: people may be reluctant to share information if systems do not feel transparent or safe. Interoperability is a consistent barrier, as many organisations still work with incompatible systems, leaving teams dependent on manual workarounds.

Achieving digital inclusion requires genuinely accessible non-digital routes: phone lines that work, in-person triage that is respectful and timely, and care pathways that do not penalise people who cannot or prefer not to use online tools. Building upon this foundation, communities need practical support to build digital confidence, delivered in ways that feel safe and trusted. Evidence from public libraries, community centres and voluntary organisations shows that digital literacy improves most when support is relational, culturally informed and embedded in places people already use.

Trusted intermediaries are critical: people who can deliver support to help residents navigate digital systems, understand online processes and make informed choices about sharing information. These roles can sit within neighbourhood teams but could also sit within housing associations, community hubs, faith settings and social care, anywhere trust is already established. When mitigations such as these are embedded from the outset, digital capability becomes a lever for widening access, not a gatekeeper that restricts it.

Neighbourhood health also faces structural risks that must be addressed early if the model is to mature. Sustainable neighbourhood working depends on shifting resources from acute care into communities, which requires credible evidence that neighbourhood approaches can reduce avoidable demand; without this, teams may be expected to deliver more without the means to do so. Workforce shortages across general practice, community services and social care further threaten stability. Clear accountability is essential, but it must be achieved without creating new layers of management that dilute local autonomy. And while colocation strengthens collaboration, suitable estate is unevenly distributed, meaning progress will rely on flexible and pragmatic use of existing spaces.

My recent work developing a frailty strategy taught me both the potential and the complexity of neighbourhood-aligned care. We brought geriatricians together with GPs, pharmacists, therapists, health navigators and the ambulance service to identify frailty earlier, prevent deterioration and divert people from hospital wherever possible through a community frailty service that offered rapid, wraparound home-based care. When admission was unavoidable, we has to make sure acute-based care was holistic, coordinated and therapy-led with the shortest possible, clinically appropriate stay. The key lesson for me was that frailty cannot be improved at a single point in the system; it is whole-pathway collaboration that prevents problems simply being shifted upstream or downstream. The challenge, as will be the case with delivering neighbourhood health, was funding: community teams must be resourced upfront, before they generate the impact that releases secondary-care capacity. What made progress possible was the passion and commitment of multidisciplinary teams and the determination of a consultant geriatrician who believed the model could work.

Neighbourhood health is not simply a structural adjustment; it is a deliberate rebalancing of the system around relationships, prevention and the lived realities of communities. Its promise lies in creating a model of care that anticipates need rather than reacts to crisis, and that supports people earlier, more consistently and with greater humanity. At its best, neighbourhood health can become a powerful engine for equity and resilience, enabling people to feel known, supported and confident in navigating their care. However there are some really difficult challenges to surmount, not least in terms of funding, workforce, digital and equity.

Digital transformation must widen access rather than narrow it, with shared records, interoperable systems and inclusive pathways that allow information to flow safely and meaningfully across teams. Funding and contracting models must evolve so resources can shift to where need is greatest, and workforce strategies must align with how people actually live, and be cared for and age in their communities. Above all, neighbourhoods must be designed around those most at risk of exclusion, and built on trust, transparency and long-term collaboration.

The neighbourhood model is the right direction, however realising that potential, however, requires some tough choices to avoid Neighbourhoods becoming another layer of a fragmented system. It remains to be seen as to whether we can build the right foundations and use the levers required to make this important vision real and workable for every community.