A first look at the new Neighbourhood Health Framework

On 17 March 2026, the Department of Health and Social Care ("DHSC") and NHS England published the Neighbourhood Health Framework, setting out the government's vision for transforming how primary, community and social care services are planned, commissioned and delivered across England.

This update is relevant for all independent providers who deliver, or wish to deliver, community, primary or integrated health services for the NHS.

Background

The neighbourhood health initiative is central to the government's 10 Year Health Plan for England, which committed to shifting care from hospital settings towards communities — what the government describes as the "left shift." The ambition is to organise NHS services around defined local populations, bringing together GPs, community health services, social care, and voluntary sector organisations to deliver more joined-up, preventative care closer to patients' homes.

The Framework, published alongside NHS England's guidance on population health delivery models, sets out the governance structures, metrics, and new contractual models through which neighbourhood health will be delivered. Integrated Care Boards ("ICBs") are being asked to begin implementing minimum requirements from the 2026/27 financial year, with more fundamental reform expected between April 2027 and March 2029.

How many new Neighbourhood Health Centres will we see and when?

The government has committed to delivering 250 Neighbourhood Health Centres ("NHCs") by 2035, with 120 to be delivered by 2030. The first wave in 2026/27 will focus largely on repurposing existing NHS buildings in areas of highest deprivation.

How will NHCs this be paid for?

The framework states that NHCs will “be a mixture of repurposed underused estate and new builds, with 20% of new builds funded from public capital, the rest through public-private partnerships.”. With 80% of then funding coming from PPPs, this marks a significant shift (albeit one that was made known late last year) back towards private finance models.   

National Delivery Targets

The Framework sets out five national goals, each with specific objectives and measurable targets to be achieved over the Medium Term Planning Framework period (April 2026 to March 2029). These represent the minimum national floor, not a ceiling, and ICBs are encouraged to go further where they can.

Goal 1: Improve Health Outcomes

The Framework targets improvements for certain high-priority cohorts — including people with frailty, care home residents, housebound patients, those receiving end of life care, and those with long-term conditions . By March 2029, the NHS aims to:

• Reduce non-elective admissions and bed days of one day or over by 10% for people with mid to severe frailty, in care homes or housebound;
• Increase the number of people identified as approaching end of life by 10%, and reduce non-elective admissions for that cohort by 10%;
• Achieve at least a 10% improvement in evidence-based clinical outcomes (as measured through QOF standards) for CVD, diabetes, COPD, mental health conditions and dementia;
• Increase the percentage of patients with diabetes receiving all eight elements of the diabetes care process bundle by 10%; and
• Reduce acute outpatient appointments for children under 16 by 10%.

Goal 2: Improve Access to General Practice

By March 2027, 90% of clinically urgent patients should be seen on the same day by their GP practice team. During 2026/27, baselines will be established for routine access and patient satisfaction, with future trajectories to be confirmed.

Goal 3: Improve Experience of Planned Care

By March 2027, the NHS aims to achieve a diversion rate of at least 25% across at least 10 high-volume specialties through single points of access, supporting the overall referral to treatment ("RTT") target of 70% of patients by March 2027, rising to 92% by March 2029. The Framework also targets a 10% reduction in secondary care follow-up appointments by March 2027.

Goal 4: Better Urgent and Emergency Care Performance

The Framework aims to keep growth flat and work towards an overall reduction in non-elective admissions for high-priority cohorts by March 2029. In terms of A&E performance, an interim 4-hour trajectory of 82% is set for March 2027, rising to 85% overall. The Framework also targets a reduction in category 3 and 4 ambulance conveyances for high-priority cohorts by March 2029.

Goal 5: Improve Patient and Staff Satisfaction

By 2027, 95% of people with complex needs should have an agreed care plan. New patient-reported experience and outcome measures will be introduced in 2026/27 with annual improvement trajectories, and a new set of neighbourhood staff experience measures will similarly be introduced with trajectories to be confirmed.

Community Health Service Waits

Separately, the Framework sets targets for community health service waiting times, requiring that at least 78% of community health service activity occurs within 18 weeks by the end of 2026/27, rising to 80% by 2028/29, alongside plans to eliminate all 52-week waits.

New Contractual Models for Neighbourhood Health

The Framework introduces three new population-based contract types, each carrying distinct implications for independent providers:

• Single Neighbourhood Providers (SNPs): SNPs will deliver integrated neighbourhood team ("INT") services within a defined neighbourhood population of around 50,000. Importantly, the Framework contemplates that SNPs could be held by primary care providers, including general practice, building on existing General Medical Services ("GMS"), Personal Medical Services ("PMS") or Alternative Provider Medical Services ("APMS") contracts. NHS England has confirmed it will consult on how SNP arrangements will interact with Primary Care Networks, raising the possibility that existing independent primary care providers could transition into or alongside SNP contract holders.
• Multi-Neighbourhood Providers (MNPs): MNPs will co-ordinate delivery across multiple neighbourhoods, typically for populations of 250,000 or more. The Framework is less prescriptive about who may hold MNP contracts, creating a potential route for larger independent and third sector providers to play a significant role in commissioning and delivering neighbourhood health at scale.
• Integrated Health Organisations (IHOs): IHO contracts will "only ever be held by NHS organisations." They give providers a whole population health budget for a defined geography. However, NHS England has indicated it will develop routes to enable "mature neighbourhood providers" to lead an IHO through alliances or joint ventures with statutory NHS bodies, which may open the door to some form of independent sector provider involvement. This raises important structural and governance questions about how such arrangements should be constituted, and what protections will be needed in any sub-contracting or alliance agreements.

SNP and MNP contracts: NHS England has confirmed it will provide further technical guidance for consultation on the implementation of novel SNP and MNP contracts, and will test out the different ways MNPs can be established and how the wider partnership of primary, community and social providers and an MNP relates to each other. Separately, NHS England will consult on how MNPs, SNPs, GMS and the PCN Directed Enhanced Service will work together, including how Primary Care Networks might evolve into SNPs. No specific date has been confirmed for this consultation, but 2026/27 will be a developmental year for all three new contracts, with DHSC and NHS England working closely with the first new SNPs and MNPs to develop the neighbourhood care model.

IHO contracts: NHS England will designate the first wave of providers eligible to hold IHO contracts in Spring 2026, and will issue further detailed guidance in a Model IHO blueprint document in the coming months. The government's plan is for a small number of IHOs to become operational in 2027. A draft Advanced Foundation Trust Programme guide for applicants — setting out how newly authorised advanced foundation trusts can apply to become designated as capable of holding an IHO contract — was published for consultation in November 2025, with the final version expected in Spring 2026.

Payment models: NHS England is working with some ICBs to develop new payment models to support neighbourhood services, including for high-priority cohorts, with the aim of reducing avoidable non-elective admissions, and will outline co-designed payment approaches for all ICBs to consider shortly.

Forthcoming Consultations and Anticipated Timelines

The Framework is explicit that detailed contract terms for all three new models are still being developed, and independent providers should be aware of the following pipeline of consultations and publications. Given this busy consultation calendar, stakeholders — including independent sector providers — will need to act promptly to engage with each of these processes.

Next Steps

For now, the next steps for stakeholders, including independent sector providers, will be to look out for and then respond to the consultations on new contract models and associated guidance. Given the breadth of the national targets now embedded in the Framework, providers should also consider how they can demonstrate their ability to contribute to the delivery of those metrics — this will increasingly be a factor in commissioning decisions.

If you would like to discuss any of the matters discussed in this article, please contact [email protected], or another member of our Healthcare Team.