The Neighbourhood Health Plan – an NHS trust and primary care perspective

Labour’s new “Neighbourhood Health Plan” (the “Plan”) forms a large part of the broader 10-year NHS reform initiative, intended to reshape and improve NHS healthcare provision across the country. In this article, Partners Nichola Halpin and Edwina Farrell consider the Plan and its implications from the perspective of both NHS trusts and primary care.  

Whilst for more complex inpatient and A&E type emergency treatment, hospitals will continue to be key, the main element of the Plan is to move some acute and inpatient healthcare out of hospitals and into community settings by creating neighbourhood health centres that will provide all other healthcare locally. These will be multi-disciplinary hubs, open 12 hours a day, six days a week. They will make it easier for people to get the support they need, when they need it; encourage early prevention to avoid issues that escalate requiring inpatient treatment; reduce pressure on overstrained hospitals and free hospitals up to focus on more complex care, so improving flow in the healthcare system.  

Setting out the operational roadmap for practical implementation of the Plan’s strategic vision is NHS England’s Operational Planning Guidance 2025/2026. This includes reducing elective care waiting times, improving ambulance response and A&E waiting times, improving access to GPs and dentists, and accelerating patient flow in mental health crisis. The Guidance includes a proposed capital investment scheme where the best performing trusts will get additional investment via tiering decisions based on performance against core national targets. The government has recently issued two lists of trusts that will receive national or regional performance management. Trusts that are deemed to be high performing have the potential to gain more autonomy and all trusts are expected to evolve into foundation trusts or integrated health organisations holding full local budgets.  

By 2035, the plan is for most outpatient services to be delivered within the community. Although this will mean a reduction in operational load for hospitals, it will also mean a reduction in their funding as funding shifts towards community- based initiatives. A concern across the board for NHS healthcare providers is the transitional pressures that may come with the implementation of these plans. Existing staff shortages will be potentially exacerbated, if only in the short-term. There is also concern about the stress caused to NHS staff going through yet another reshuffle. In addition, that lack of funding may hinder full realisation of the ambitious Plan. Extensive reorganisation and lack of funding will likely trigger redundancies.  

The cornerstone role of primary care cannot be overstated in the delivery of the government’s Plan as services are moved out of hospitals to other providers within a more local and community setting.  

General practice has been encouraged to work more collaboratively for many years and PCNs (Primary Care Networks) are a potential blueprint for the way in which primary care will operate within the new proposals. The ambitious Plan, however, will expect much more. Whilst we await the new GP contracts promised as part of the Plan proposals for some detail, it is expected that we will see more diagnostic work and treatment from multi- disciplinary teams in one- stop shops. This is considered to be what the public want and what is ultimately of benefit to continuity of care and care provision generally. This is not new and several leading general practice organisations were part of the vanguard programme in the last decade which provide for teams of specialists from across care provision to serve their communities. This provides many opportunities for providers but will need to be backed with a fair percentage of the health care budget which, historically, has not been the case for primary care.  

It is clear that primary care has a major part to play and the need to provide for capacity has never been more vital. Whilst some plans suggest use of existing estate, to make hubs really local, and especially given the concept of initial concentration in the development in areas where health need is greatest, it is unlikely that all hubs can be provided by the utilisation of existing space large enough to accommodate what is needed, where it is needed.   

There are major roles for other providers too, all of whom work in the primary care sector – plans for dental reform and more work to promote the role of pharmacy and optometry are included within the proposals. 

The new teams will need to be local, and the new contracts outlined suggest that these will be referenced to geographies and population – just like the primary care networks which, no doubt, encourages the idea of these organisations being developed to align with the new Plan.  

Real success will need greater collaboration across, not only the entire health care system, however, but integration with the social care system.