Neighbourhood health is here: our analysis of what it means for your estate strategy

The UK Government’s Neighbourhood Health Framework was published on 17th March 2026. Built directly on the ambitions of the 10 Year Health Plan for England from July 2025, it sets out a clear programme to reorganise NHS care around communities. For everyone responsible for healthcare buildings, estate strategy and capital investment across England, the implications are significant and the timescales are already live.

Here is our analysis of what it means for you.

The “left shift” in plain terms

The framework’s central mission is to move care out of hospitals and into communities. Services will be organised around natural local populations of around 50,000 people and delivered through Integrated Neighbourhood Teams (INTs), bringing together GPs, community nurses, social workers, mental health practitioners and specialist clinicians.

The physical anchor of this model is the Neighbourhood Health Centre (NHC). These are genuinely ambitious, purpose-designed community hubs that bring together care, support and community services under one roof in a way the NHS has not done before which we believe will provide truly comprehensive care and improve general health.. A fully realised NHC is designed to bring together:

• GP and primary care services
• Community diagnostics
• Mental health services
• Adult and children’s social care
• Best Start Family Hubs
• Wider community support including employment advice, housing services and voluntary sector provision

Getting the design right for that breadth of services, creating spaces that are welcoming, accessible for all and genuinely responsive to the diverse communities they serve, requires a level of experience and ambition that goes well beyond standard healthcare planning.

The pipeline: what we know

The government has committed to a substantial, time-bound programme, aiming to deliver 250 NHCs by 2035, 120 of those by 2030.

Wave 1 (2026/27): Focused on repurposing underused NHS Property Services and LIFT (Local Improvement Finance Trust) estate, with a clear priority on areas of highest deprivation.

Future waves will combine further repurposing with new build solutions, funded through 20% public capital and 80% public-private partnerships. The Office for the Impact Economy (OfIE), recently launched by the Prime Minister, will also facilitate investment from social investors and philanthropists to further strengthen the programme.

This is a real pipeline, and Wave 1 is already underway. The work is not on the horizon, it is happening in estates teams and commissioning conversations across the country right now.

Archetypes are coming: plan with that in mind

One detail worth noting for estates teams is that the framework commits to publishing a model NHC definition, describing different archetypes of provision to inform both the repurposing of existing buildings and new build solutions. Alongside this, the Medium Term Planning Framework references the development of governance archetypes to help local systems adopt more standardised models. Both are significant. In practical terms, it means that while early Wave 1 work is already underway, a clearer national picture of what an NHC should look like, spatially and operationally, is still emerging. 

We would encourage estates teams and capital planners not to wait for that definition before beginning feasibility work, but to build enough flexibility into early strategies to respond as the archetypes become clearer. Getting the right advice now, while remaining adaptable, is the right approach. We have access to, and in many cases are actively defining, the very latest healthcare models and their implementation, and would be happy to assist you in developing your own locally relevant models.

Repurposing first: the strategic priority

The framework is clear that Wave 1 prioritises existing estate. The One Public Estate (OPE) approach is reinforced throughout, with ICBs asked to work closely with local authorities to make better use of libraries, leisure centres and community buildings as part of the neighbourhood health estate.

For estates and capital teams, this signals a significant early pipeline of condition surveys, feasibility studies and option appraisals. The question is not simply whether a building is available, but whether it is truly suitable and what it would take to make it work for the NHC model. Getting technically grounded, experienced advice at this early stage is critical to delivering at pace and within budget.

There is also a sustainability case that matters increasingly in business case approvals and planning submissions. Reusing existing structures substantially reduces embodied carbon, and demonstrating this clearly will strengthen investment arguments for commissioners and local authorities alike. We are already seeing this become a more active part of the approval conversation, and it will only grow in importance.

Understanding the new commissioning hierarchy

For estates teams, understanding where decisions are made is as important as understanding what needs to be built. The framework introduces a clear tiered contracting structure.

ICB (Integrated Care Board): Holds system-wide responsibility and awards population-based contracts across the system.

IHO (Integrated Health Organisation): Accountable for health outcomes across a large population footprint. Initially open to high-performing NHS Trusts, IHOs receive a whole-population health budget and are incentivised to invest in community-based prevention. Where hospital admissions reduce as a result of neighbourhood care, the IHO can reinvest the savings.

MNP (Multi-Neighbourhood Provider): Co-ordinates delivery across multiple neighbourhoods, serving populations of around 250,000 or more.

SNP (Single-Neighbourhood Provider): Delivers integrated services at neighbourhood level, serving populations of around 50,000. Primary Care Networks (PCNs) are expected to evolve into this model over time.

GP practices: Remain the foundational layer of primary care throughout.

For capital planners and estates leads, this hierarchy directly shapes how business cases need to be constructed, which organisations hold decision-making authority at each stage and which conversations need to happen first.

Building a business case: the metrics that matter

Business cases for NHC investment will need to articulate clearly how the built environment supports measurable health outcomes. The framework sets out eight core national metrics:

• A 10% reduction in non-elective admissions and bed days for frailty cohorts by March 2029
• A 10% improvement in clinical outcomes for key long-term conditions (CVD, diabetes, COPD and dementia) by March 2029
• 90% same-day GP access for clinically urgent patients by March 2027
• A 25% referral diversion rate through single points of access by March 2027
• A 10% reduction in outpatient follow-up appointments by March 2027
• A reduction in Category 3 and 4 ambulance conveyances for high-priority cohorts by March 2029
• Improved Emergency Department (ED) four-hour performance to 82% by March 2027, rising to 85% by March 2029
• 95% of people with complex needs to have an agreed personalised care plan by 2027

Estate strategies that connect clearly to these outcomes will be better positioned to secure commissioning support, navigate governance approvals and access funding through the new contractual models. We have found this framing increasingly persuasive when working with clients on investment cases, and the framework now formalises it.

Beyond healthcare: the regeneration opportunity

One aspect of this framework that we find compelling is that the long-recognised links between social and environmental factors and general health is now informing healthcare policy.  This framework’s ambition is to connect health with wider community regeneration with NHCs explicitly designed to co-locate healthcare with housing advice, employment support, social care and voluntary sector services. The Pride in Place programme is backed by £5.8 billion and is a 10-year regeneration initiative investing up to £20m each into over 330 disadvantaged communities.  This directly intersects with neighbourhood health in its aim to invest in overlooked and underserved places.

This means neighbourhood health sits firmly at the heart of healthcare, housing, employment and community renewal. For those of us working across healthcare and wider regeneration and public sector estates, this creates real opportunities to design places that serve communities in a much broader, more holistic sense. It is exactly the kind of challenge we find inspiring, and one where our broad cross-sector experience genuinely makes a difference.

The strategic planning challenge

The framework asks ICBs and HWBs to agree neighbourhood footprints, aligned where possible with emerging local government reorganisation boundaries. Mapping existing assets, assessing population need, prioritising investment across a complex multi-site programme and aligning everything with the new commissioning hierarchy is a demanding exercise.

It requires strategic analytical capability alongside practical estate expertise across multiple disciplines. Planning at programme level, across multiple sites and multiple stakeholders simultaneously, will be essential for ICBs, local authorities and NHS Trusts working through this landscape together.

Act now: the foundations are being laid in 2026/27

The framework is explicit that this financial year is the year for laying foundations. ICBs must already be agreeing neighbourhood footprints, establishing INTs for high-priority cohorts and confirming estate plans. For estates teams and capital planners, that means acting now on several fronts:

• Reviewing existing estate condition and suitability against the NHC model
• Identifying repurposing opportunities within NHS Property Services and LIFT portfolios
• Engaging with your ICB and HWB on emerging neighbourhood footprints and strategic commissioning plans
• Aligning your estate strategy with the national outcomes metrics
• Exploring OPE and public-private partnership funding routes ahead of Wave 2 and beyond

Stage 2 runs from April 2027 to March 2029, with Neighbourhood Health Plans formally agreed and incorporated into ICB strategic commissioning plans. The pace and scale of delivery will increase significantly from that point.

How we can support you

We understand the complexity of multi-stakeholder NHS and local authority projects. We have wide experience across community health buildings, GP surgeries, mental health facilities and wider public sector estate. We work across the full estate lifecycle, from early condition surveys and feasibility studies through to design, delivery and asset management.

Our architects, building surveyors, masterplanners, geomatic specialists, interior designers, landscape designers, health planners and project managers work together as one integrated, multidisciplinary team. This means we can support you at every stage of the process, from initial condition and measured surveys, feasibilities studies and business case development, through masterplanning, concept design and technical delivery, right through to asset management. 

One team, one conversation, across every stage of the journey.  We understand the complexity of multi-stakeholder NHS and local authority programmes, and we are already working with clients on projects directly aligned with the neighbourhood health agenda.

We would welcome the opportunity to share our thinking, work through the implications of the framework for your estate strategy and help you build the right foundations for what comes next. 

Get in touch with us directly to start the conversation