The New NHS: From Integrated Care Systems to Neighbourhood Health

Executive summary

The NHS in England is entering its most significant structural and operational change since the introduction of Integrated Care Systems (ICSs) in 2022. The direction of travel is set out in the 10-Year Health Plan for England, published in July 2025, which seeks to move the NHS from a hospital-centred, reactive service towards a more preventative, digitally enabled and community-based model. Its three central shifts are hospital to community, analogue to digital, and sickness to prevention.

The emerging model is best understood as a set of interconnected layers rather than a single new organisation:

• Neighbourhoods will become the frontline unit for integrated, proactive care, generally serving populations of around 50,000.
• Neighbourhood Health Centres (NHCs) will provide physical bases for primary, community and selected secondary-care services, although neighbourhood health is an operating model rather than simply a building.
• GP practices, Primary Care Networks (PCNs) and GP federations remain central to primary care delivery but are increasingly expected to work at greater scale and integrate with community, mental health, social care and voluntary-sector services.
• Integrated Care Boards (ICBs) are being reshaped into more strategic commissioners, responsible for allocating resources, improving population health and shifting investment towards prevention and community services.
• Integrated Care Systems (ICSs) remain the partnership framework bringing together the NHS, local government and wider partners across a population.
• Integrated Health Organisations (IHOs) are emerging as a possible contractual model for integrating pathways, rather than as a new statutory tier of NHS organisation.

There has already been substantial progress. In April 2026, the ICB landscape was reorganised: 12 ICBs were abolished, six new ICBs were established and one existing boundary was expanded. Neighbourhood health guidance, a national neighbourhood health framework, new population-based commissioning models and detailed guidance for neighbourhood health centres have also been published. The first wave of NHC upgrades has been identified, with the government committing to 250 neighbourhood health centres by 2035, including 120 by 2030.

The fundamental change, therefore, is not simply another NHS reorganisation. It is an attempt to change where care happens, how organisations work together, how money flows and how populations are managed.

1. The strategic direction: the three shifts

The 10-Year Health Plan provides the overarching framework for reform. It identifies three major changes.

First is hospital to community. Rather than waiting for people to become sufficiently unwell to require hospital treatment, the NHS is intended to provide more proactive care close to home. Neighbourhood teams will bring together general practice, community health, mental health, social care, pharmacy, local government and voluntary-sector organisations around defined populations.

Second is analogue to digital. The NHS App is intended to become the principal digital front door, allowing people to access advice, appointments, records and care plans. Digital technology, artificial intelligence, genomics and remote monitoring are intended to support both access and clinical decision-making.

Third is sickness to prevention. The NHS is expected to identify risks earlier, improve vaccination and screening, address major risk factors and use population-health data to target interventions before illness becomes more serious. The objective is not simply to treat disease more efficiently, but to reduce the amount of avoidable illness entering the system.

These three shifts explain much of the new organisational architecture.

2. Neighbourhoods: the new frontline

At the bottom of the new structure is the neighbourhood.

The neighbourhood is intended to be the level at which professionals organise themselves around the needs of a defined local population rather than around institutional boundaries. The emerging national model envisages populations of approximately 50,000 people, although local flexibility is explicitly allowed.

Neighbourhood working builds on structures that already exist, particularly Primary Care Networks, but goes considerably further. The aim is to establish integrated multidisciplinary teams capable of identifying people at risk, coordinating care and intervening before conditions deteriorate.

Initial priorities include people with frailty, people living in care homes, people who are housebound or approaching the end of life, and people with complex long-term conditions. The NHS is also encouraging areas to extend neighbourhood teams into areas such as children and young people’s health, mental health, learning disability, autism and ADHD.

The important distinction is that a neighbourhood is not simply another administrative tier. It is intended to become the practical unit through which care is organised.

3. Neighbourhood Health Centres

Neighbourhood Health Centres are the physical infrastructure supporting this model.

The 10-Year Health Plan envisages NHCs as convenient local facilities, open for at least 12 hours a day, six days a week, bringing together general practice, community services and potentially diagnostics, rehabilitation, mental health, urgent care and other services.

The centres are intended to be built around general practice, usually at approximately PCN scale, while enabling other organisations to work alongside primary care. They may also provide space for local-authority and voluntary-sector services.

However, the distinction between a neighbourhood and an NHC is important. The neighbourhood is the model of care; the NHC is one of the facilities that enables it. Care may also be delivered in people’s homes, GP practices, pharmacies, community facilities and digitally.

In April 2026 NHS England published detailed planning and design guidance for NHCs. The government subsequently confirmed an ambition for 250 centres by 2035, with 120 by 2030, and the first wave of upgrade schemes has already been identified.

4. General practice, PCNs and GP federations

General practice remains the foundation of neighbourhood health.

Individual GP practices will continue to provide registered-list care, but the direction of policy is towards greater collaboration between practices. Primary Care Networks already provide an important organisational bridge: groups of practices working with community, mental health, pharmacy, social-care and voluntary-sector partners.

The 2026/27 GP contract explicitly strengthens the relationship between PCNs and neighbourhoods. Where a natural community does not correspond with existing PCN boundaries, PCNs may need to work with their ICB to achieve greater alignment.

GP federations are different again. They are usually locally constituted organisations through which GP practices collaborate at a larger scale. They can provide infrastructure, workforce, clinical services and operational capacity across multiple practices. Federations are not a statutory NHS tier and their form varies considerably between areas.

Their potential significance is nevertheless growing. The 10 Year Health Plan proposes new GP contracting arrangements designed to encourage GPs to work over larger geographies and lead neighbourhood providers.

Federations can therefore become important vehicles for delivering neighbourhood services at scale, although the precise relationship between practices, PCNs, federations and emerging neighbourhood providers will vary locally.

5. ICBs: from broad commissioners to strategic commissioners

The Integrated Care Board is the statutory NHS organisation within an ICS.

ICBs hold NHS budgets and are responsible for planning and commissioning services for their populations. Under the new operating model, their role is increasingly becoming strategic rather than operational. They are expected to determine population need, allocate resources, commission for outcomes and shift expenditure towards prevention and community services.

This is a significant change in emphasis.

The ICB of the future should be less concerned with managing every operational detail and more concerned with asking:

• What health outcomes does our population need?
• Where are inequalities greatest?
• Which services should be provided locally?
• How can hospital demand be reduced?
• Where should investment move from acute care into community care?
• Which providers can deliver the best outcomes and value?

This strategic role is reinforced by the restructuring of ICBs. On 1 April 2026, 12 ICBs were abolished and six new ICBs established, with further changes expected as local-government reorganisation develops.

The intention is to create larger, more resilient commissioning organisations while reducing administrative cost. Some ICBs are also operating in clusters with shared leadership and teams, although clustered ICBs remain separate legal entities with their own duties and allocations.

6. ICSs: the partnership system

An Integrated Care System is broader than an ICB.

The ICS brings together the ICB, local authorities, NHS providers, the voluntary and community sector and other partners. Its purpose is to improve population health, reduce inequalities and coordinate services across organisational boundaries.

The ICS therefore provides the strategic partnership framework, while the ICB is the statutory NHS commissioning organisation within it.

Most ICSs contain place-based partnerships, which sit between the system and neighbourhood levels. Places are often aligned with local authorities or groups of local authorities and provide a bridge between system strategy and neighbourhood delivery.

The emerging hierarchy can therefore be visualised as:

National NHS and DHSC
↓
Regions
↓
ICB / ICS
↓
Places
↓
Neighbourhoods
↓
GP practices / PCNs / neighbourhood teams / community services

This should not be interpreted as a rigid management hierarchy. The new model is deliberately intended to be more networked, with responsibilities distributed according to the task.

7. Where do IHCs fit?

One terminology point is important. “IHC” is not currently a standard national organisational tier in the NHS architecture described by the 10-Year Health Plan and 2026 NHS England framework. The national documents instead refer to Integrated Health Organisations (IHOs).

If “IHCs” is being used locally to mean integrated health communities or integrated health centres, these should be understood as local delivery arrangements rather than a statutory tier.

The emerging Integrated Health Organisation model is more significant. NHS England describes IHOs as a contractual delivery model rather than a new organisational form. They are intended to allow providers to redesign whole pathways across organisational boundaries, potentially involving subcontracting and, where appropriate, delegated commissioning.

This distinction matters because the NHS is not creating another statutory organisation between the ICB and neighbourhood. Instead, it is experimenting with contracts that enable organisations to behave more like integrated providers.

8. What has already been achieved?

Although the 10-Year Health Plan runs until 2035, implementation has already begun.

First, the ICB structure has changed. The April 2026 reorganisation reduced the number of statutory ICBs through 12 abolitions and six new establishments, with the intention of creating a more strategic and efficient commissioning architecture.

Second, neighbourhood health has moved from concept to implementation. NHS England issued neighbourhood health guidelines in 2025 and has subsequently published a national neighbourhood health framework and detailed implementation guidance. The framework establishes practical requirements for 2026/27, including reducing avoidable admissions, improving community services and developing neighbourhood plans with local government.

Third, the physical infrastructure programme has started. Guidance for NHCs was published in April 2026, including planning requirements, design specifications and funding arrangements. The first wave of upgrades has been identified.

Fourth, new commissioning models are being developed. NHS England has published its population-health delivery model and is consulting on Single Neighbourhood Provider and Multi-Neighbourhood Provider contracts. These are intended to create contractual mechanisms for delivering integrated neighbourhood services.

Fifth, general practice is being aligned with the new architecture. The 2026/27 GP contract includes specific requirements around neighbourhood alignment, while the medium-term planning framework requires ICBs to address variation in GP access and capacity.

Sixth, the NHS is already scaling community-based interventions. Before the 10-Year Health Plan was published, NHS England reported improvements in areas such as community mental health access, Urgent Community Response and community pharmacy services.

Conclusion

The new NHS is best understood not as a single reorganisation but as a redistribution of responsibility and activity.

The ICB is becoming a strategic commissioner; the ICS is the partnership framework; places connect system strategy with local delivery; neighbourhoods become the principal unit of integrated care; and general practice, PCNs, GP federations and community providers form the frontline.

The ultimate test will be whether this architecture changes what patients experience. The 10-Year Health Plan is explicit that care should happen as locally as possible, digitally by default, at home where possible, in a neighbourhood health centre when needed and in hospital when necessary.

If successfully implemented, the result should be an NHS that identifies need earlier, manages more illness in the community, uses hospitals for genuinely specialist care and gives local organisations greater responsibility for improving the health of their populations. The challenge is that organisational reform alone will not achieve this. Success will depend on workforce, funding, digital infrastructure, clinical leadership, local government collaboration and—above all—the ability to translate the new structures into genuinely integrated care.

References

1. Department of Health and Social Care, 10 Year Health Plan for England: Fit for the Future, July 2025. GOV.UK – 10 Year Health Plan
2. Department of Health and Social Care, 10 Year Health Plan – Executive Summary, 2025. GOV.UK – Executive Summary
3. NHS England, Integrated Care Boards in England, updated April 2026. NHS England – Integrated Care Boards
4. NHS England, Integrated Care in Your Area, updated 2026. NHS England – Integrated Care Systems
5. NHS England, Neighbourhood Health Guidelines 2025/26. NHS England – Neighbourhood Health Guidelines
6. NHS England, Neighbourhood Health Framework, 2026. GOV.UK – Neighbourhood Health Framework
7. NHS England, Neighbourhood Health Centre Guidance, 2026. NHS England – Neighbourhood Health Centres
8. NHS England, Medium Term Planning Framework 2026/27–2028/29. NHS England – Medium Term Planning Framework
9. NHS England, Changes to the GP Contract in 2026/27. NHS England – GP Contract 2026/27
10. NHS England, Fit for the Future: Towards Population Health Delivery Models, March 2026. NHS England – Population Health Delivery Models
11. NHS England, Multi-Neighbourhood Provider and Single-Neighbourhood Provider Contracting Models, July 2026. NHS England – Neighbourhood Provider Contracts
12. Department of Health and Social Care, 10 Year Capital Plan for Health and Social Care, July 2026. GOV.UK – 10 Year Capital Plan