The newly published Neighbourhood Health Framework (NHF) lands at a defining moment for primary care. After several months of policy drift following the publication of the government’s 10 Year Health Plan and intensifying system pressures, the framework now starts to crystallise something fundamental for primary care – its critical role in the system.
In that context, the NHF’s arrival feels less like a blueprint and more like the first meaningful attempt in years to realign national ambition with frontline reality. There will be those that see it as a real opportunity to achieve long-lasting change and really focus on the needs of our communities whilst others will see is as another well-intentioned policy that adds pressure without solving problems.
For our members, the question is not whether, but how we can ensure that primary care not only sits at the heart of neighbourhood but is leading and driving how we turn this policy into practice on the ground, at a local level. So, in that context its permissive tone is welcome – a model that emphasises flexibility rather than prescription; a recognition that the health of a neighbourhood cannot be standardised.
But with this freedom comes responsibility. If primary care is to take a leading role in shaping the shift to a new model of care, it must be prepared to embrace neighbourhood working not as an add-on, but as a fundamental shift in how care is organised, governed and delivered. The neighbourhood model will challenge individual providers to think differently – not about their patients, but about their population – and to take a leading role in coordinating care, working with others, for that population.
This is not about diminishing the role of individual general practice, community pharmacy or any other part of primary care. For general practice, this is about building on one of the NHS’s most unique assets: the registered patient list – and recognising that the skills of primary care – continuity, coordination and risk management – are exactly what the wider system now needs most.
The NHF rightly recognises that transformation will not be immediate. Neighbourhood plans will evolve rather than arrive fully formed, and capabilities will mature at different paces. Yet the opportunity is undeniable: the NHF provides primary care with a route to meaningful local leadership and a chance to position itself at the centre of population health, rather than simply the manager of access.
The decision not to impose a national definition for Integrated Neighbourhood Teams (INTs) reflects this pragmatism. Structural reforms have too often been undertaken with little regard for how teams work on the ground. Allowing neighbourhoods to shape teams around relationships rather than organograms is a major step forward. But flexibility alone is insufficient. If primary care is to lead, it requires the essentials of modern system working: clear governance, functional data‑sharing, transparent decision‑making and delegated budgets that enable genuine autonomy, not symbolic involvement.
The NHF also signals a shift in national goals—reducing avoidable hospital activity and achieving 90% same‑day access. These ambitions echo what primary care has long argued: meaningful system sustainability depends on upstream investment, strengthened community capacity and improved digital and diagnostic infrastructure.
We have already seen what is possible in areas where systems have strategically partnered with primary care. These places have harnessed the power of the registered list, the accessibility of high‑street providers such as eyecare and community pharmacy, and the strengths of voluntary and local government partners. They have begun to change the conversation about what neighbourhood‑based care can achieve. The challenge now is to ensure that this becomes the norm rather than exception.
But this will require national backing. Our members increasingly tell us: “We have the relationships, we get it, we have the vision—what’s next?” To answer that question, the Government must provide tangible levers for local leaders so that they are supported to drive forward delivery. That includes unpicking the complex, outdated financial architecture. These are not theoretical barriers; they are practical obstacles that make it harder for primary care leaders to stitch together a coherent neighbourhood offer with local partners.
Financial reform remains one of the biggest unresolved questions. Neighbourhood working depends on shifting resources out of acute settings and into prevention, continuity and community capacity. While the NHF acknowledges this, it stops short of explaining how it will be achieved. Without decisive action on financial flows, the question ‘what will be different this time?’ will linger. The most advanced primary care organisations have only progressed because they have had dedicated improvement support, neighbourhood‑level programme management, and discretionary investment. In contrast, many areas—often those with the highest need—lack even the foundational infrastructure.
Yet infrastructure reform alone will not deliver neighbourhood transformation. The cultural shift required is profound. Neighbourhood working demands collaboration across professional boundaries, alignment of priorities across organisations, and a genuine willingness to share power—something the NHS has long struggled with. It requires a shift from organisational loyalty to neighbourhood responsibility. Primary care is already ahead of the curve; the rapid evolution of primary care networks (PCNs) demonstrates how quickly general practice can adapt when given space and support. It’s vital that we build and preserve the infrastructure of PCNs that have been crucial in bringing General Practice leaders together while supporting them with the time and investment to be outward facing in the development of single and multi-neighbourhood providers. But cultural leadership should not be assumed—it needs investment, nurturing and visible backing from national and system leaders.
Ultimately, the success of the NHF will come down to relationships, not structures. Systems must place far greater emphasis on building trust, strengthening partnerships and enabling primary care to lead—not through expectation, but through empowerment.
The next three years will be pivotal. If systems use the NHF’s permissive intent to build primary care capability, invest in neighbourhoods and shift resource into prevention, this could be the moment primary care has long been working toward. If not, it risks becoming another layer of well‑meaning policy rhetoric that becomes disconnected from the realities of primary care. As the NHS Confederaation transitions to the NHS Alliance, we will continue to make this case clearly and consistently, bringing the experience of frontline primary care into the conversations that will shape what comes next.
