From hospital to community? - The good, the bad, and the ugly of the 10-year plan to move care to the community

Sep 28, 2026

Uploaded by Grenda

Editorial examining England’s published Labour 10-year health plan (3 July) and its first strategic shift: moving care from hospital to community. It evaluates the proposed Neighbourhood Health Services and centres, including multidisciplinary teams and new neighbourhood contracts, and weighs potential benefits for general practice, prevention, and social determinants. It also critiques gaps in implementation, engagement, financial assumptions, integration risks, and evidence quality, raising concerns about governance and oversight.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

From hospital to community?

The good

The bad

What next?

Editorials From hospital to community? The good, the bad, and the ugly of the 10-year plan to move care to the community Luisa M Pettigrew, Jake Beech, Hugh Alderwick and Judith Smith Labour’s 10-year health plan for England, published on 3 July, set out three strategic shifts—from hospital to community, sickness to prevention, and analogue to digital.1 This editorial focuses on the first—shifting care from hospital to community—and considers its implications for general practice, drawing on existing evidence to explore the good, the bad, and the potentially ugly. The proposed shift from hospital to community hinges on the development of Neighbourhood Health Services, delivered by multidisciplinary community-based teams—including GPs, nurses, pharmacists, paramedics, and a mix of other staff. The plan also proposes Neighbourhood Health Centres (NHCs), to be open at least 12 hours a day, 6 days a week, and offering colocated NHS, local authority, and voluntary sector services. To incentivise the delivery of these services, the plan proposes two new neighbourhood contracts—a ‘single neighbourhood’provider contract aiming to build on primary care networks (PCNs), covering a population of around 50 000; and a ‘multineighbourhood’ contract to cover a population of around 250 000, aiming to support back-office functions, digital transformation, estates, data analytics, and quality improvement. While large-scale GP organisations, such as federations, may be able to take on multi-neighbourhood contracts, they will also be open to NHS Trusts. Operating at a larger scale, integrated health organisations (IHOs) are also proposed. To be led by the ‘very best’NHS Foundation Trusts, IHOs would hold the whole health budget for a defined population. The plan states these will become the ‘norm’ overtime. The good health and care, and signals a review of the general practice funding formula to address disparities in resource allocation. In addition, NHS leaders have described an intention for a‘tight-loose-tight’ approach: being tight on aims, loose on the mechanisms to achieve them, and tight on measuring outcomes.5 If this degree of local flexibility is realised, primary care teams and other local organisations will have some freedom to develop Neighbourhood Health Services in ways that best meet local needs while staying aligned with national goals. The bad A big problem with the plan is that it lacks an implementation strategy and does not sufficiently engage with lessons from past initiatives. Integrated Care Pioneers and Vanguard New Care Models in the 2010s, which aimed to bring together primary, community, and secondary care providers under new contracts, failed to scale due to contracting complexity, funding uncertainty, and limited evidence of impact.6–9 In the late 2000s, Darzi Polyclinics were labelled ‘white elephants’ as they were deemed to be costly, often duplicative of other services, and viewed as a threat by many GPs.10 NHS walk-in centres received similar criticisms.11 NHCs, if not carefully planned and integrated with existing general practices, may face the same fate. Financially, the plan rests on optimistic assumptions. The 2.8% annual funding uplift to the NHS announced in the spending review is below the long-term historical average of 3.7% and far below the major increases seen during the 2000s under the last There are welcome aspects of the plan for primary care. First, the plan is ambitious, making a strong case for change. It draws attention to pressures facing the NHSand the need to shift care closer to home, which builds on efforts already underway to scale-up community-based services and aligns with long-standing aspirations to move away from hospital-centric models.2–4 Second, it provides a welcome focus on prevention and recognises the importance of the social determinants of health, proposing, for example, to colocate employment and debt support services within NHCs. Third, the plan re

FAQs

What is the main shift discussed in the editorial?

The editorial focuses on shifting care from hospital to community, as part of England’s 10-year health plan.

What proposals support the move to community-based care?

It highlights Neighbourhood Health Services delivered by multidisciplinary teams and Neighbourhood Health Centres open at least 12 hours a day, offering NHS, local authority, and voluntary sector services.

What are the editorial’s key concerns about the plan?

Concerns include the lack of an implementation strategy, insufficient engagement with past initiative lessons, optimistic funding assumptions, integration risks for NHCs, and selective or weak evidence underpinning some claims.

Sep 28, 2026

Uploaded by Grenda