Neighbourhood Health: From Buildings to Systems – A 360 Degree Society Perspective

Executive Summary

National policy across the Neighbourhood Health Framework, Neighbourhood Health Centre (NHC) guidance, and the emerging ICB commissioning blueprint signals a clear strategic shift: towards population health, prevention, and care delivered at neighbourhood level.

This represents one of the most significant reorganisations of the health system in decades. It reframes Integrated Care Boards (ICBs) as strategic commissioners, positions neighbourhoods as the primary unit of delivery, and promotes multidisciplinary working across health, care and civil society.

However, there is a critical gap between policy ambition and delivery model.

While the language of prevention, community and wider determinants is strong, the underlying mechanisms remain focused on:

• service integration

• estate planning

• clinical utilisation

• financial affordability

This creates a real risk that neighbourhood health centres become more efficient clinical buildings, rather than engines of community-led prevention and health creation.

From a 360 Degree Society perspective, the opportunity is to go further:

• from health centres to neighbourhood health campuses

• from co-location to relationship-based systems

• from commissioning services to commissioning healthier places

The question is no longer whether the NHS builds neighbourhood health centres — but whether it uses them to activate the full potential of neighbourhoods.

1. A System in Transition: The Policy Context

Neighbourhood health is now positioned as a central pillar of the NHS 10-Year Health Plan, aiming to:

• improve access to general practice

• reduce reliance on hospitals

• shift from reactive care to prevention

• integrate services around people’s lives [1]

Neighbourhood Health Centres are described as:

• “the place to go for most health needs”

• a key tool for delivering integrated, multidisciplinary care [1]

Alongside this, the ICB blueprint redefines the role of systems:

• ICBs become strategic commissioners, not operational managers

• focus shifts to population health, resource allocation and market shaping

• delivery moves to providers and place-based partnerships [2]

This aligns with wider commentary from The King’s Fund, which highlights a return to strategic commissioning — but in a context of rising demand, worsening outcomes, and growing inequality [3].

Taken together, this is a fundamental shift:

From managing services → to shaping population health systems

2. What the Policy Gets Right

There are important strengths in the current direction.

2.1 Recognition of neighbourhood as the organising unit

The model emphasises:

• care closer to home

• multidisciplinary teams

• neighbourhood footprints (~50,000 population) [1]

2.2 Asset-based thinking (in principle)

NHCs are expected to:

• sit within “asset-based neighbourhood models”

• connect to community activity and wider support networks [1]

2.3 Integration beyond health services

Guidance supports alignment with:

• social care

• welfare advice

• employment support

• community-led activity

• children and family services [1]

2.4 Anchor institution role

Centres are framed as:

• contributors to regeneration

• drivers of footfall and local economic activity

• part of wider place-based development [1]

These elements align strongly with a broader understanding of health as shaped by place, relationships and opportunity, not just services.

3. The Core Gap: Prevention Without a Delivery Model

Despite this ambition, the model remains underdeveloped where it matters most.

3.1 Commissioning remains service-led

ICBs are expected to:

• assess need

• plan services

• allocate resources

• monitor outcomes [2]

But this still operates within a traditional commissioning cycle.

Prevention is framed as:

• proactive care

• early intervention

• risk stratification

Rather than:

• building community capability

• investing in social infrastructure

• enabling everyday health creation

As The King’s Fund notes, this risks becoming:

“the same commissioning cycle, applied to a different set of priorities” [3]

3.2 Success metrics reinforce this bias

Approval criteria for NHCs focus on:

• GP scale and access

• left-shift from hospitals

• utilisation

• affordability

• deliverability [1]

These are important — but they are system efficiency measures, not measures of:

• community wellbeing

• social capital

• prevention impact

• neighbourhood resilience

3.3 Community remains peripheral to funding

While civil society is referenced throughout policy:

• there is no clear model for funding community partners

• no requirement for long-term investment in VCFSE capacity

• no mechanism for commissioning social infrastructure

This creates a structural imbalance:

Clinical services are funded as core delivery.

Community capacity is treated as supplementary.

4. The Estate Problem: Occupied but Underutilised

The guidance strongly emphasises:

• reuse of existing estate

• improved utilisation

• extended opening hours

• rationalisation before new build [1]

But this reflects a narrow definition of utilisation.

In reality:

• many health buildings are busy during clinic hours

• but largely inactive evenings and weekends

• underused socially, culturally and economically

This is not just an estates issue.

It is unused prevention capacity and lost public value.

A room can be “occupied” in NHS terms, but still fail to:

• host community activity

• support peer networks

• enable learning, culture or social connection

From a population health perspective:

The question is not whether buildings are full — but whether they are fully alive.

5. Investment Models and the Risk to Community

The funding model sharpens this challenge.

• 80% of new builds expected via PPP routes [1]

• strong emphasis on:

  • revenue affordability

  • utilisation

  • long-term financial sustainability

This creates a bias toward:

• stable, billable services

• NHS tenants

• predictable income streams

Community organisations — often:

• lower income

• more flexible

• less predictable

and therefore risk being priced out of the core model.

Unless explicitly designed in, community becomes:

• residual

• subsidised

• or excluded altogether

6. A Different Model: The Neighbourhood Health Campus

A more ambitious interpretation is needed.

6.1 From centre to campus

Neighbourhood health should not be defined by a single building, but by a network of local assets, including:

• schools and nurseries

• churches, mosques and faith organisations

• community centres

• informal social networks

• GP practices and pharmacies

• housing associations and landlords

• local businesses and employers

• leisure, culture and civic spaces (including green and blue assets)

These are the institutions that:

• hold long-term presence

• build trust

• shape daily life

6.2 The role of the NHC

In this model, the NHC becomes:

• a node within a wider system

• a platform for coordination and activation

• not just a site of service delivery

It can:

• map neighbourhood assets

• identify gaps and overlaps

• convene local partners

• support shared priorities

6.3 Neighbourhood governance

There is also a governance opportunity.

Health and wellbeing boards operate at system level.

Neighbourhood health requires place-level partnership structures.

A neighbourhood forum could bring together:

• primary care

• schools and early years

• housing

• VCFSE anchors

• employers and local business

• faith and community leaders

This is not formal governance, but relational infrastructure:

• aligning action

• building trust

• enabling collaboration

6.4 Integration with wider policy

This approach aligns with:

• Pride in Place

• regeneration strategies

• community asset transfer

The guidance already points to these links [1].

The opportunity is to make them operational, not just contextual.

7. Implications for ICBs as Strategic Commissioners

If ICBs are now strategic commissioners, the key question becomes:

What are they commissioning through neighbourhood health?

A 360 approach would expect commissioning to include:

• community activation of estate

• out-of-hours use

• VCFSE as core delivery partners

• social prescribing ecosystems

• employment, skills and wellbeing activity

• peer support and community-led interventions

This moves from:

• commissioning services

to:

• commissioning healthier places

8. Conclusion

National policy is moving in the right direction.

It recognises:

• neighbourhood as the unit of delivery

• prevention as a priority

• integration across systems

• the importance of community and place

But the delivery model is not yet aligned.

Without stronger mechanisms for:

• commissioning prevention

• sustaining community partners

• activating estate beyond clinical use

• building neighbourhood-level relationships

there is a real risk that Neighbourhood Health Centres become modernised service hubs, rather than engines of neighbourhood health.

The opportunity is clear:

The future of neighbourhood health should not be one building serving a population,

but a neighbourhood campus that mobilises the institutions, relationships and assets already rooted in place.

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References

[1] NHS England (2026) Neighbourhood Health Centre Guidance for Regions and Integrated Care Boards

[2] NHS England (2026) Update on the Draft Model ICB Blueprint and Future NHS Operating Model

[3] The King’s Fund (2026) Same cycle, different bike? Strategic commissioning and population health