The Government’s 10-Year Health Plan marks a fundamental shift in how healthcare is delivered, moving away from a system centred on treating illness in hospitals and towards one prioritising prevention, early intervention and support within communities. But the rollout of its new centres won’t be a simple case of copying the success stories.
Designed as one-stop shops with healthcare, social support and community services accessible closer to home, NHCs aim to reduce pressure on hospitals and address wider health determinants including housing, employment and social isolation. Bringing together general practice, diagnostics, rehabilitation, mental health support, and local authority and voluntary sector provision, they recognise that health is influenced as much by the communities people live in as the healthcare they receive. While the vision is compelling, translating the ambition into a scalable reality presents several challenges.
Image 1: The Cavell Community Health and Wellbeing Hub, designed by Medical Architecture and Architype
Image 2: The Jean Bishop Integrated Care Centre, designed by Medical Architecture Photo: Jill Tate
1
Juggling national policy and local reality.
One of the most fundamental difficulties will be mastering this tricky balancing act. NHS England envisages neighbourhoods serving around 50,000 people but communities vary enormously in geography, demographics, deprivation levels and existing infrastructure. What works in an inner-city borough with strong transport links and a concentration of services may be entirely unsuitable for a rural community struggling with workforce shortages and dispersed populations.
This challenge is not new. Many see the NHC programme as an evolution of the NHS Local Improvement Finance Trust (LIFT) model, which developed modern community healthcare facilities through public-private partnerships. While many LIFT buildings were successful in improving healthcare environments, concerns emerged around cost and flexibility. Facilities were often developed to a very high specification, resulting in occupancy costs that some healthcare providers found difficult to justify.
To avoid perpetuating these kinds of challenges, each NHC should be shaped by a robust assessment of local needs, existing services and community assets. Flexible building design, combined with locally tailored service models, will be essential if centres are to remain relevant and financially sustainable over time.
2
Ensuring equitable investment.
Funding and investment decisions raise another concern. There is a risk that communities most in need of improved healthcare infrastructure could lose out to areas where developments are easier to deliver or more commercially attractive. Such an outcome would undermine one of the programme’s core objectives: reducing health inequalities.
Investment decisions should therefore be informed by indicators such as deprivation, life expectancy, disease burden, access to primary care and wider determinants of health. Prioritising communities with the greatest need will maximise both health impact and value for public investment.
3
Addressing workforce capacity.
Many NHS services already face significant recruitment and retention pressures. These are often greatest in rural and coastal areas, making it difficult to expand community-based care. Delivering more services within neighbourhood settings will require not only additional staff but new multidisciplinary ways of working.
Current workforce shortages illustrate the scale of the challenge. Clinical psychology services, for example, report vacancy rates of 10-12% nationally, with some specialist community mental health teams experiencing rates exceeding 20%.
Similar shortages across general practice and community nursing continue to limit access to timely care. Without addressing these constraints, there is a risk that NHCs could place additional pressure on an already stretched workforce rather than improve access to services.
Alongside investment in new facilities, each NHC should be supported by a local workforce strategy that focuses on recruitment, retention, training and collaboration across organisations. Without sufficient capacity, centres risk becoming underutilised assets rather than thriving hubs of integrated care.
Image: The Cavell Community Health and Wellbeing Hub, designed by Medical Architecture and Architype
4
Building effective partnerships.
The NHC model depends upon collaboration between NHS organisations, local authorities, voluntary sector organisations and community groups. Bringing together these stakeholders sounds straightforward in principle but is often complex in practice. Organisations frequently operate under different funding regimes, governance structures and strategic priorities.
NHCs should establish clear governance arrangements, shared outcomes and joint decision-making processes from the outset. Strong partnerships will be essential to delivering truly integrated care that extends beyond traditional healthcare services.
5
Understanding and investing in community social infrastructure.
There is limited understanding and strategic planning of the community social infrastructure that underpins health and wellbeing. While the Government’s vision for NHCs emphasises prevention and stronger links with local communities, many areas lack a clear grasp of the community assets, organisations and spaces that already support people’s health.
Community centres, libraries, sports clubs, faith organisations and voluntary groups play a vital role in promoting physical health and mental wellbeing. Unfortunately these assets are often poorly understood, inconsistently planned for and, in many places, have been eroded through funding reductions and redevelopment. As this preventative social infrastructure declines, increasing numbers of people may rely on NHS services for issues that could otherwise have been addressed through community support.
Despite its importance, there is no consistent approach to assessing, planning or investing in social infrastructure. Many local authorities lack an overarching strategy, while decision makers often have limited data to inform investment. Without a shared understanding of local assets and needs, NHCs risk duplicating existing provision, overlooking valuable community organisations and missing opportunities to strengthen prevention.
Successfully embedding NHCs within communities will require dedicated local leadership. Each centre should have a coordinator responsible for bringing together partners across health, local government and the voluntary sector, ensuring clinical services are integrated with both the ‘hard’ infrastructure of buildings and facilities and the ‘soft’ infrastructure of community organisations, networks and relationships. This will enable NHCs to become genuine hubs for prevention.
What works in an inner-city borough with strong transport links and a concentration of services may be unsuitable for a rural community struggling with workforce shortages and dispersed populations.
Coming soon:
Catterick Integrated Care Centre (CICC)
Since 2015, the NHS and the Ministry of Defence have been working together on plans to enhance health and care services for Catterick Garrison and the wider Richmondshire area. Now this purpose-built facility, imminently due to open between Colburn and Catterick Garrison, will bring health and social care services together under one roof.
This joint collaboration is the first of its kind between the NHS and MOD and will bring integrated health and social care services to military personnel, their dependants and veterans, as well as residents in Catterick and the Richmondshire area.
As well as primary care, services will include rehabilitation, dental care, mental health support and other treatments. Emergency and specialist hospital care will continue to be provided by existing local hospitals, but the CICC will complement their services by expanding outpatient capacity and supporting earlier, more convenient access to routine and community-based care. Among teams relocating to CICC:
- Vulnerable Veteran and Adult Dependents Service part of the North Yorkshire Talking Therapies (currently based at North Moor House)
- Adult mental health community west team (currently based at Colburn Surgery)
- Community mental health services for older people in Hambleton and Richmondshire (the Richmondshire team only)
- Services currently delivered from spaces used at Harewood GP Practice and Colburn Surgery will be hosted within the new CICC
Images courtesy of BDP
NHCs should be rooted in local communities and build upon existing social infrastructure. There is often a gap between consulting communities and genuinely co-designing services with them.
6
Embedding genuine community co-design.
Community engagement remains an unresolved challenge. NHS England emphasises that NHCs should be rooted in local communities and build upon existing social infrastructure. However, there is often a gap between consulting communities and genuinely co-designing services with them.
The Bromley by Bow Centre in East London is one of the UK’s best-known examples of community-led, integrated care. Rather than functioning solely as a GP practice, it brings together primary healthcare with welfare advice, employment support, education, social prescribing, community activities and social enterprise, all shaped through long-term collaboration with residents and local organisations.
Its success demonstrates that effective neighbourhood health models are built on deep relationships, community ownership and a thorough understanding of local needs, rather than healthcare services alone. However, Bromley by Bow is not a blueprint that can simply be replicated elsewhere.
Its success has evolved over decades in response to the unique characteristics of its local community. Attempting to copy the model without adapting it to local priorities, assets and relationships risks losing the very qualities that made it successful.
Community engagement should move beyond one-off consultations towards ongoing co-design throughout planning, implementation and operation. Residents should play an active role in shaping priorities, evaluating services and identifying future needs, ensuring that each NHC reflects the unique characteristics and aspirations of the community it serves.
7
Keeping prevention at the centre.
Perhaps the greatest strategic risk facing the programme involves focusing too heavily on building new facilities rather than delivering preventative interventions. NHCs have the potential to become transformative community assets, but new facilities alone will not deliver better population health. Simply relocating services from hospitals into community settings does not address the underlying causes of poor health.
To realise their full potential, NHCs must be viewed as part of a wider ecosystem of health creation. Success should be measured not simply by the number of buildings delivered or appointments provided, but by improvements in population health, reductions in inequalities, stronger community resilience and a reduced need for avoidable healthcare. Investment must extend beyond healthcare facilities to include the community organisations, services and social infrastructure that enable people to live healthier lives.
Ultimately, the challenge of establishing NHCs is not primarily one of construction but of transformation.
The programme must avoid becoming a rebranding exercise for existing estates or a new generation of expensive healthcare buildings. Instead, it must create flexible, locally owned and sustainable centres that genuinely integrate services, empower communities and promote wellbeing.
If these challenges can be overcome, NHCs could become the cornerstone of a more preventative, equitable and community-focused healthcare system. If not, they risk becoming another well-intentioned reform that falls short of its ambitions.
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