NHS 10-year Plan: From Hospital To Community: The Promise And The Problem Of Neighbourhood Health 

Chapter Two of the NHS 10‑Year Plan introduces one of its most radical and hopeful ideas; a fully integrated, community led Neighbourhood Health Service. 

If realised, it could transform the way patients experience care, bringing General Practice, community pharmacy, diagnostics, social care, mental health and prevention into one cohesive, locally delivered system. 

It’s a great idea. One-stop neighbourhood hubs. Same day access to GPs. Extended hours. Integrated records. Local diagnostics. Seamless transition between home, primary and hospital care.  

The ambition is clear, to move away from episodic, hospital centred, fragmented care and build something personal, proactive and local. 

But as anyone working inside the NHS will tell you, ambition is the easy bit. 

Reality check – GPs are on the brink 

In theory, neighbourhood teams offer an answer to what ails the NHS. In practice, they are being layered onto a foundation, General Practice, already showing signs of structural collapse. 

Across my work with GPs, federations and PCNs, I’ve heard variations of the same concern: “This model only works if we’re still standing.” 

Staffing is tight, premises are crumbling, and morale is low. Many practices are dealing with unsustainable demand, exhausted teams and a lingering sense of being left behind. In urban areas, property constraints and patient volume create bottlenecks. In rural areas, recruitment and distance present their own challenges. 

The plan talks about building Neighbourhood Health Centres, with extended hours, wraparound teams and digitally supported access. But where will the money come from? 

Since the plan was published, we have heard repeatedly that there is no new money for neighbourhood health implementation. Systems must deliver these changes from existing budgets. Neighbourhood transformation will not be funded through central investment. Sites must find their own way. 

That statement has landed heavily. Because without capital investment for premises, funding for double running models during transition or new revenue for GP leadership time, many are asking; how exactly do we deliver this? 

Why GPs feel excluded from the vision 

In public, the plan champions General Practice. Chapter Two says: “General Practice is the foundation of the NHS,” and “neighbourhood health will succeed only if General Practice thrives.” It promises an end to the “8am scramble,” more GPs and easier access. 

But behind closed doors, many GPs are asking whether they are truly seen as co-architects, or just as conduits for yet another redesign imposed from above. 

A recent GP Online article echoed this frustration – neighbourhood health cannot succeed without thriving General Practice. That message has been repeated again and again by Local Medical Committees, PCN Clinical Directors, and GP Federations.  

There is a real fear that while the rhetoric may centre General Practice, the delivery mechanisms often exclude it. 

Take the proposed contracts. The plan introduces two new General Practice contract models, designed to allow larger geographic footprints and multi-disciplinary teams. In theory, these offer flexibility. In practice, many GPs fear these are stepping stones to a model that edges out the independent contractor status and pulls General Practice into larger, less locally accountable structures. 

As one GP put it to me recently: “We’ll be starved into integration. By the time the neighbourhood teams are fully formed, they’ll no longer need us as leaders, they’ll already have taken over the structure.” 

Learning from past reforms of the NHS 

For those of us who’ve worked through Practice Based Commissioning, Primary Care Homes, PCNs and Integrated Care Systems, this moment feels familiar.  

Once again, the NHS is trying to rewire itself around “place-based care.” Once again, General Practice is positioned as central to success. And once again, the practical tools, money, workforce, premises and time, are either missing or insufficient. 

This is why so many GPs remain sceptical. Not cynical, but cautious. They’ve been here before. Promises of transformation without delivery lead to burnout, disillusionment and disengagement. 

To avoid repeating those mistakes, this chapter must be implemented with three core principles; co-design, capacity building and contractual clarity. 

Co-design Neighbourhood Health Services or collapse 

Neighbourhood Health Services will only succeed if they are designed with, not for, General Practice. This means engaging GP leaders in pathway development, operational planning, governance models and workforce planning. Not through consultation exercises but through genuine partnership. 

As I argue in my new book Embedded, the best system changes happen when clinical credibility meets commercial capability. This is where industry can support. Pharma, medtech and device companies working with GP partners can help deliver the transformation the NHS wants, if their offers are structured around the real problems on the ground. 

Capacity before change 

You cannot move care out of hospitals and into communities without building the capacity to receive it. This means: 

• Investing in premises. Community diagnostics and multidisciplinary teams can’t operate from converted terraced houses or portable buildings. 
• Expanding the workforce. Not just more GPs, but nurses, paramedics, pharmacists and care coordinators. 
• Funding the transition. If GPs are to double run existing care and develop new models, they need paid time and backfill. 
• Streamlining the digital infrastructure. Shared records, appointment booking, messaging platforms; all must work seamlessly across teams. 

Without these fundamentals, neighbourhood care will become an administrative burden, not a clinical enabler. 

GP contracts must do more than enable 

The proposed new General Practice contracts are intended to unlock larger footprints and workforce flexibility. But many GPs are asking, at what cost? 

There is concern that choosing not to adopt the new contracts could limit access to Local Enhanced Services (LES), investment flows, or influence over neighbourhood teams. This is not an idle fear. We’ve seen similar dynamics with PCNs, where those who stayed outside often found themselves excluded from development opportunities and funding conversations. 

Clarity is urgently needed. What will be the default model? What protections exist for traditional partnerships? And will new models come with meaningful autonomy, or just more central control? 

Opportunities for pharma, medtech and device companies 

For companies operating in the health system, the shift to neighbourhood care is both a challenge and a chance to embed more deeply. But success will depend on aligning with what GPs and neighbourhood teams actually need. 

Key opportunity areas include: 

• Community diagnostics. Portable, accurate, easy to deploy testing tools that can be used in GP practices, health centres or even patients’ homes. 
• Remote monitoring and digital therapeutics. Tools that help primary care manage long term conditions safely and proactively, freeing up appointments. 
• Workforce augmentation. Services that include training, protocols or additional staffing to help practices deliver new models without additional burden. 
• Integrated care pathways. Offers that go beyond the pill or device, supporting prevention, early detection, triage and self-management. 
• Infrastructure innovation. Modular consultation pods, virtual ward tech and shared record integration tools all contribute to enabling care outside hospital walls. 

The best offers will not just fit in with the NHS 10 Year Plan, they will actively solve the problems GPs are raising. And they will include implementation support, with training, real world evidence and shared success metrics. 

Bottom line – the neighbourhood model will fail unless GPs are brought in from the cold 

Neighbourhood Health Services are a vision that needs grounding. They could be one of the most important reforms of the decade. If done right, they can increase access, reduce hospital dependency, empower patients and narrow health inequalities. 

But none of that is possible without a thriving General Practice. And General Practice is not thriving. 

To realise this vision, NHS leaders must move from rhetoric to resourcing, from high level ambition to detailed delivery. GPs need investment, autonomy and genuine partnership. Without that, the neighbourhood model will remain just that, a model, not a movement. 

For suppliers, now is the time to align your offer. Not around features but around transformation. Not around transactions but around systems. This is your chance to become truly embedded. 

At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners and system leaders to implement real change. We then help pharma, medtech, and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities, and get their innovations embedded into care pathways. 

With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his upcoming book, launching September 2025, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Embedded shows you how to reframe your offer, align with NHS priorities and make change stick.