Neighbourhood Health Centres: opportunity knocks…once again
A response to NHS England’s Neighbourhood Health Centre Guidance (April 2026)
Thought-piece by Rob Trimble — Partner at Bromley by Bow Health since 2005 and Chief Executive of the Bromley by Bow Centre 2002–2022
The NHS England Neighbourhood Health Centre Guidance deserves a clear-eyed response. After three decades working across primary care, grassroots community regeneration and social enterprise I find myself holding two different views at the same time: real optimism about what this programme could become and deep frustration about the journey and destination described in the current roadmap.
The NHC programme signals genuine institutional commitment to moving healthcare closer to communities. The ambition to create 250 centres by 2034, the multi-disciplinary model, the acknowledgement that health cannot be delivered by clinicians alone — these point in the right direction. At its best, the NHC framework is an invitation. The problem is that it is written in the language of compliance rather than liberation; and is simply not radical enough. There is an implied acknowledgment that good health is principally driven by social factors, but an underpinning assumption that a successful NHC will be defined by how it more efficiently organises multidisciplinary teams in a single building, rather than how it might meaningfully pass the ownership of health resources into the hands of communities.
The potential
What the guidance gets right is the recognition that health is produced in communities, not just delivered by clinicians. The NHC framework could — if NHS England has the courage to allow it — become the vehicle through which a generation of community entrepreneurs finally get the platform, the estate, and the institutional backing they have always lacked.
The Bromley by Bow Centre was one early example of what becomes possible when you refuse to draw hard boundaries between health, community, enterprise, the arts, green space and human connection. We were not unusual in our instinct — we were unusual in having the space and the partners to act on it. NHCs could give many more organisations that same opportunity. But the case for flexibility is not simply ideological. We have known for decades that 80% of health outcomes are driven by social determinants. A programme that creates impressive buildings staffed by excellent clinicians and allied professionals, but fails to address these upstream factors will make a marginal difference at best.
What is missing?
The omissions are as telling as what the guidance contains:
• The creative arts — entirely absent, despite a substantial evidence base for their foundational and consistent role in good health outcomes.
• Social enterprise and business — some of the most innovative health-generating work in the UK has been done in this space.
• Community ownership of assets — the words point to local power; the structures point to central control.
• Green space and horticulture — a remarkable omission given the evidence on their broad therapeutic and transformative value.
• Funding for non-clinical services — social prescribing is promoted whilst its funding base is eroded and the resourcing of the non-statutory services it refers into are being decimated.
What is also absent is animation and excitement — a sense of embedding a broad range of health-generating enterprises that already exist in many communities and that an NHC could draw in as genuine partners. From therapeutic barber shops and community grocers to dance studios and open-air community living rooms and so many more exciting examples. In the best community health models these are not optional extras. They are the point.
Take stock and get it right
The targets of 120 NHCs by 2030 and 250 by 2034 are bold — and potentially a trap. The speed is determined by political cycles, not by any serious ambition to understand what works. A more useful approach would be to begin with genuine diversity: fund 12–15 meaningfully different delivery models, working with organisations within and outside the health-world that have a track record in community-led innovation, study them seriously, then scale what works.
The Canadian Community Health Centre movement, celebrating its centenary in 2026, offers an instructive comparison — a model founded on understanding social determinants, community governance models and multi-sectoral partnerships. It required sustained commitment and openness to allow communities to be the authors of their own health, not just the recipients of services.
Perhaps it’s not too late
NHS England has a choice. It can insist on fidelity to the template — and create 250 well-resourced and shiny MDT polyclinics that improve access to statutory services. Or it can explicitly invite and resource flexible interpretation: identify people and organisations with a track record in community development, social enterprise and place-making, and give them real freedom within the NHC framework. It can be open to new governance and ownership models and encourage true innovation.
There are enough of those people, and enough of those organisations, to make this work. The question is whether the system is willing to trust them.