Neighbourhood health guidelines 2025/26: what you need to know

Overview

• Neighbourhood health aims to create healthier communities. The new guidelines are designed to help integrated care boards (ICBs), local authorities, and health and care providers progress neighbourhood health initiatives in 2025/26, before the ten-year plan’s release.  This guidance came out alongside the operational planning guidance and Better Care Policy Framework.
• Integrated neighbourhood teams (INTs) featured in last year's operating guidance, but this is the first guidance specifically on the neighbourhood health service from NHSE since the new government.
• All parts of the health and care system will need to collaborate closely to support people's needs, building on existing efforts through primary care networks, provider collaboratives and collaboration with the voluntary, community, faith and social enterprise (VCFSE) sector. Creating a collaborative high-support, high-challenge culture with a shared vision and outcomes, define geographical boundaries and joint accountability with visible clinical and non-clinical leadership, effective processes, and optimal funding. 
• In the next year, integrated care systems (ICSs) are asked, in partnership with local authorities and working NHS regions, to strengthen the ‘core components’ that enable neighbourhood health; bring together integrated service offers; scale up innovation and strengthen evaluation. The intention is this will set the foundations for scaling and expanding the neighbourhood approach over the coming years, including a more formal evaluation framework.
• Systems have been asked to focus initially on adults, children and young people with complex health and care needs, those who require support from multiple services and organisations. Success should: streamline access, decrease pressure on acute care, slow deterioration and additional conditions, maximise community services, improve staff and patient experience and work better with communities.

Core components

Population health management: Systems should create a linked dataset for population health outcomes, risk stratification and strategic resource allocation that includes various health and social care data, and expanded over time to include wider central government, qualitative and quantitative insights. Where systems do not already have an existing tool, they must work with the NHS Federated Data Platform team to select one which is compatible. 

Modern general practice: ICBs support general practice to implement the Fmodern general practice model. This involves streamlining the access, making it easier to connect with the right healthcare professionals including through Pharmacy First and digital self-service options like the NHS app. Staff will have access to a single workflow of structured information.

Standardising community health services:  Community health services should be commissioned and integrated as part of a neighbourhood health plan, using the Standardising Community Health Services publication to ensure funding meets local needs. Care should address both physical, mental health and social care needs to provide seamless, joined-up care. Additionally, mental health support should be enhanced through schemes like the Additional Roles Reimbursement Scheme and NHS Talking Therapies with a focus on integrating services for children, young people, and those with substance misuse issues by leveraging existing LA, VCFSE and education services. 

Neighbourhood multi-disciplinary teams (MDTs): Like the Fuller Stocktake, it proposes INTs should provide proactive, planned and responsive care based on population needs. These teams will oversee and deliver a range of services including holistic assessments, case reviews, care planning and coordination of services, with a core team managing complex cases and linking to extended specialist resources as needed. Best practice includes a core team for complex cases, with a wider team enabling access to additional specialist resource and assigning a care coordinator to each person.

Integrated intermediate care with a ‘home first’ approach: Systems should provide short-term rehabilitation, reablement and recovery services through working in an integrated way to deliver a therapy-led approach. Referrals can be directly from the community or as part of hospital discharge planning, using a ‘home first’ approach with home-based assessments and interventions and collaboration with urgent neighbourhood services. Effective implement case management systems and outcome measurements, aligned with the Better Care Fund policy framework for 2025-2026, are essential for optimal resource use. 

Urgent neighbourhood services: For escalating or acute health needs, community response and virtual ward services must be aligned to local demand, ensuring coordination through a single point of access (SPOA). Senior clinical decision-makers in a SPOA should provide advice and referrals before ambulance dispatch and offer clinical advice to other healthcare professionals to avoid unnecessary emergency calls and improve the ambulance service. Ensure efficient use of resources in step-up and step-down pathways to prevent avoidable admissions and support timely discharges, with service footprints determined locally to provide seamless services for everyone.                                                                                                                         

Making a start

• ICBs and local authorities jointly plan a neighbourhood health and care model that includes partnerships to create a flexible workforce that collaborates across local communities through the Better Care Fund. Commissioning models, new funding flows and contractual mechanisms to facilitate joint planning and exploring the use of neighbourhood buildings across all partners, including local government, following on from recent ICB-led estates strategy work
• Embed, standardise, and scale the six core components of neighbourhood health, ensuring that provider capacity and structures are aligned to meet demand effectively.
• Tackle health inequalities when by getting the basics right (ensuring accessibility for people with disabilities and implementing reasonable adjustments), engaging with local communities as equals, particularly those historically underserved, and analysing outcomes by population demographics, deprivation, age, ethnicity, disability and inclusion health groups. 
• Implement a consistent, system-wide approach to population health management using quantitative data and qualitative insights to understand and address the needs and risks of different population cohorts.  Use this data to guide care design, delivery and commissioning decisions to empower frontline staff and promote person-centred care.
• Consider how to evaluate the impact of the changes in a systematic, consistent and scalable way to build the case for future expansion and link to the triple aim of improving population health outcomes, people’s experience of health and care services and value for money.
• Secondary care clinicians should collaborate with out-of-hospital teams to provide specialist advice and input to neighbourhood MDTs, enable continuity of care, support hospital-at-home services and develop integrated frailty pathways to improve patient outcomes and reduce unnecessary hospital.

Information will be made available on a national implementation programme where at least one place in every system, which is already demonstrating a more advanced approach to delivering neighbourhood health, will receive facilitation and evaluation support alongside progress monitoring to identify what is working most effectively and the optimal conditions for success.

Analysis      

Our members will welcome the commitment from NHS England to develop a neighbourhood health strategy with healthy communities at its heart, a focus on those who need it most and a recognition this is a new way of working beyond the NHS. In responding to rising demand, worsening population health and widening health inequalities the neighbourhood health service will need to be central to the operating landscape for the NHS of the future. 

We recognise this guidance is a stepping stone ahead of the ten-year plan. Like the operating guidance, there is a focus on ‘recovery’ and the role of neighbourhood teams in urgent care, management of conditions and demand. This is to be expected in the short term and is the right focus today. While the guidance highlights the potential of more cross-sector working and a strong relationship with citizens, it does not offer a comprehensive understanding of what ‘neighbourhood health service’ would look or feel like for citizens or staff. 

We hope the ten-year plan includes a comprehensive definition of the model and plan for a neighbourhood health service that goes well beyond joint-planning and multi-disciplinary team-based care.

This would need three components:

Firstly, it complements the NHS’s bio-medical model with a psycho-social approach. Addressing the needs of high-intensity users of NHS service through a holistic and person/community-centre model.  As the guidance states, these patients comprise around 7 per cent of the population but use up to 46 per cent of hospital costs, and this does not account for wider system resource. Yet, despite all that activity, we often fail to help them improve their lives.   

The emphasis needs to be on seeing the patient in the round, helping them solve whatever problems are most standing in their way and, ultimately, empowering them to take greater control of their lives and their health. This kind of approach is not only more effective and more compassionate but, by reducing demand and unnecessary activity, it saves money.  

...it is important the focus on neighbourhoods is built around trusted bodies, and familiar expertise rooted in communities

Secondly, to fulfil its potential neighbourhood health needs a stronger and deeper relationship with communities.  We know that the public sector can benefit from working respectfully with communities, seeing people and their relationships and connections as assets to be drawn on to promote health and wellbeing.  We shouldn’t miss the potential of neighbourhood working to drive a step change in our relationship with the people we serve and who most need us. We hope to see more of a commitment to this in any future guidance and the ten-year plan. 

Finally, it is important the focus on neighbourhoods is built around trusted bodies, and familiar expertise rooted in communities. For the NHS, this is typically general practice or community pharmacy - the providers on the corners of many local villages or towns. But equally, many citizens put their trust and value in the voluntary and community sectors. We need to strengthen what already exists across many parts of the country and, as the guidance references, simplify channels to access it. The role of modern general practice is a central component in the guidance but what also need to be ‘core’ is recognition for all the assets across a community and harnessing these. 

We know for this to work it will require change at every level, appropriate metrics for success, high-quality population health data and outcome-focused evaluation. All of which have been recognised by NHSE and prioritised in the guidance. 

Insight from our existing work on neighbourhoods shows that continuous learning and improvement should be a focus at all levels.  Our members will be encouraged by the improvement and continuous learning approach by NHS and its focus on the role of ‘place’ as core to delivering change. Place is vital to creating the infrastructure and integration for this model to succeed. We know across the country that primary care networks, provider collaboratives, trusts and place-based partnerships play a leading role in supporting the delivery, evaluation and strategic planning of neighbourhood models. Work is underway in many parts of the country and support should not be just exclusively for certain areas. We encourage the NHS to have a wider national improvement offer to prevent it from feeling like a ‘pilot programme’ and preventing progress in neighbouring areas. 

The NHS Confederation is committed to continuing to advocate for a radical transformation towards neighbourhood health and supporting our members across all parts of the system to share learning, drive improvement and develop effective evaluation methods that help this change happen.