The NHS Neighbourhood Health Framework, published in March 2026, set out an unambiguous ambition: bring care closer to home, reduce avoidable hospital pressure, and tackle health inequalities through a fundamentally different model of out-of-hospital working. What it did not set out – at least not yet – is the precise contractual architecture, the funding mechanisms, or the governance standards that will underpin it.
That gap is being used by many primary care leaders as a reason to wait.
ICBs have been tasked with submitting local neighbourhood plans. Those plans are being developed now. The question for every PCN Clinical Director and Federation Manager is simple: are general practice voices properly reflected in them, or is the model being shaped around you rather than with you?
What We Know Is Already Enough to Act On
Waiting for complete national clarity before preparing is not caution – it is delay with consequences. Here is what is already certain enough to build on:
- The five goals of the neighbourhood health framework are fixed: improving health outcomes, strengthening GP access, reducing planned care waits, improving urgent and emergency care, and delivering better care planning. These will not change materially.
- PCNs remain central. The recent changes to the PCN DES – specifically the introduction of local variation agreements – confirm that ICBs can now vary certain DES services and payments to commission for locally specific outcomes. General practice is not being bypassed; it is being kept at the heart of neighbourhood delivery.
- The need for left shift is real. Significant hope is attached to investment following activity as services move out of secondary care. History suggests this does not happen automatically – and those who can evidence need, model, and outcome are best placed to make the case.
- Neighbourhood plans are being developed. Local systems are preparing first drafts. If you do not know what is in yours, find out today.
The Six Foundations You Can Build Right Now
Rather than waiting for the full picture, primary care leaders should be building readiness across six practical areas – regardless of how the final model is configured. These are not speculative; they are the foundations that any credible neighbourhood model will require.
1. Leadership with a mandate
Neighbourhood health needs a named lead with a clear brief – not a vague instruction to keep an eye on things. That person or small group needs time, authority, and organisational backing to map what exists, identify gaps, and represent primary care in wider system conversations. If that is not yet in place, it is an urgent first step.
2. Clarity on roles, decisions, and escalation
Who decides what in your neighbourhood? Who is accountable if something goes wrong across organisational boundaries? Who speaks for general practice when a local authority or trust makes a proposal that affects practice workflows? These questions sound basic but are genuinely unanswered in most areas. An operating model – even a simple one – that maps decision rights and escalation routes will save enormous time and conflict later.
3. Continuous, shared governance
More integrated working means more complex accountability. As neighbourhood models bring together community providers, local authorities, voluntary sector organisations, and primary care under a shared service offer, governance cannot remain siloed. Complaints processes, safeguarding protocols, incident management, training assurance – all of these need to work across organisational boundaries. If you cannot evidence safety in a shared pathway today, you are not ready to scale.
4. One tested integrated pathway
Do not attempt to integrate everything at once. Choose one priority pathway – frailty, mental health, proactive long-term condition management – and test whether the joined-up working is clear enough for a busy member of staff to use on a difficult day. Map the patient journey from referral to follow-up. Identify where delays occur, who holds responsibility, and what information is shared. A tested pathway is a solid blueprint for everything that follows.
5. A neighbourhood evidence pack
Commissioners and collaboratives will increasingly expect primary care to come to the table with data, not just views. A short evidence pack – covering local need, key gaps, patient feedback, current strengths, and a small number of priority improvement areas – is the difference between participating in neighbourhood commissioning and shaping it. Public health teams can help. Population health management tools can accelerate it. Start to collate yours now.
6. Infrastructure that makes assurance continuous
When services are stretched, governance becomes a chore – policies are searched for in inboxes, training records are chased individually, and evidence is reconstructed rather than maintained. The organisations that will lead neighbourhood health confidently are those where assurance is built into delivery infrastructure: shared platforms, current documentation, accessible training records, and live visibility of compliance across partner organisations.
The Cost of Waiting
There is a reasonable version of caution. It sounds like this: ‘We will engage properly once the guidance is clearer.’ But neighbourhood health is not waiting for guidance to land before taking shape. Relationships are being formed, priorities are being set, and commissioning conversations are happening – right now, in your ICB, in local trusts, or place-based partnerships, possibly without a general practice voice at the table.
The organisations that will be best placed when investment does flow – whether through local variation agreements, single neighbourhood provider contracts, or future funding mechanisms – are the ones that can demonstrate readiness: clear leadership, tested pathways, credible evidence, and governance that works across boundaries.
That readiness is built in months, not weeks. The time to start is not when more guidance arrives. It is now.
This content is brought to you in collaboration with AtScale. AtScale work with PCNs and federations across England to build the governance infrastructure, leadership capability, and evidence base needed to lead in a changing NHS.