The Department of Health and Social Care published the Neighbourhood Health Framework on 17 March 2026. It is the most significant structural reform to primary care since the creation of Primary Care Networks in 2019, and it will reshape how your practice operates, who you work with, and what you are accountable for between now and March 2029.
This article explains the framework in plain terms: what the new structures are, what they mean for your practice, and the dates you need in your diary.
In brief: The Neighbourhood Health Framework organises NHS services around geographic neighbourhoods. GP practices will work in Integrated Neighbourhood Teams alongside professionals from community health, mental health, pharmacy, and social care. The framework sets minimum expectations across access, digital systems, population health, and integrated working, with implementation running from April 2026 to March 2029. PCNs may evolve into the new provider structures through a consultation process.
What is the Neighbourhood Health Framework?
The framework is the implementation plan for the neighbourhood element of the government's 10 Year Health Plan. It moves NHS service delivery from organisational boundaries (your practice, the community trust, the mental health trust) to geographic neighbourhoods where teams from different organisations work together on shared patient populations.
The logic is straightforward: a frail 82-year-old with heart failure, diabetes, and limited mobility currently has their care split across a GP, a community matron, a heart failure nurse, a diabetic nurse specialist, a social worker, and a pharmacist, none of whom routinely talk to each other. The framework puts those professionals into a single team, working from shared data, with shared accountability for that patient's outcomes.
This is not a white paper or a consultation document. It is a framework with named structures, defined responsibilities, and specific targets. Implementation guidance will follow, but the direction of travel is set.
The new structures your practice needs to understand
The framework introduces five organisational tiers. You do not need to memorise all of them, but you do need to understand where your practice sits and who you will be working with.
Integrated Neighbourhood Teams (INTs)
These are the teams that will affect your practice most directly. An INT is a multidisciplinary team bringing together professionals from different organisations to serve a defined neighbourhood population. The framework does not specify INT size or composition nationally, as this will vary by local need, but you can expect teams to include some combination of:
GPs and practice staff
Community nurses and district nurses
Clinical pharmacists
Mental health practitioners
Social care workers
Allied health professionals (physiotherapists, occupational therapists)
INTs will focus on defined priority cohorts (more on these below). The key change for practices is that INT staff from other organisations will work alongside your team. You will share patients, share data, and share accountability for outcomes.
What this means in practice: Expect joint meetings, shared care plans, and clinical staff from other organisations becoming a regular presence in your neighbourhood. Your practice will need processes for coordinating with INT colleagues, sharing patient information appropriately, and contributing to neighbourhood-level population health goals.
Single Neighbourhood Providers (SNPs)
An SNP delivers integrated services within one neighbourhood (~50,000 population). This is the organisational entity that holds the contract for neighbourhood-level service delivery.
The framework indicates that PCNs might evolve into SNPs, with a consultation expected on whether and how that transition happens. Your GMS, PMS, or APMS contract remains nationally determined and is not affected by this change.
What this means in practice: If your PCN is functioning well, it is likely to become or form the basis of your SNP. If your PCN is struggling, this is the point at which that becomes a structural problem rather than just an inconvenience.
Multi-Neighbourhood Providers (MNPs)
MNPs coordinate consistent service delivery across multiple neighbourhoods, typically covering around 250,000 people. They work with SNPs and practices to ensure services are joined up across a wider footprint.
What this means in practice: In practice, MNPs are likely to provide shared functions such as IT support, workforce planning, training programmes, and quality improvement across your area. Think of them as the operational layer above your PCN/SNP.
Integrated Health Organisations (IHOs)
IHOs sit above MNPs and hold whole population health budgets. They are responsible for integrating hospital, community, primary care, and social care funding into a single budget for a defined population.
What this means in practice: IHOs are primarily relevant to commissioners and system leaders rather than individual practices. However, they will determine the funding flows that reach your neighbourhood, so understanding who your IHO is and what their priorities are will matter for business planning.
Health and Wellbeing Boards (HWBs)
HWBs are existing local authority bodies that take on an enhanced role under the framework. They will develop neighbourhood health plans and define the geographic boundaries of neighbourhoods.
What this means in practice: Your local HWB will decide which neighbourhood your practice belongs to. If you are near a boundary, this could affect which INT you join and which SNP you are part of. Engage with this process early.
What the framework expects of GP practices
The framework sets minimum expectations that ICBs must implement across their systems. While these are directed at ICBs rather than individual practices, they will flow down to you through contracts, commissioning, and local implementation plans. Here are the key requirements that will land on your desk.
1. Meet the 90% same-day urgent access standard by March 2027
Already read our same-day access readiness sprint? The April 2026 contractual obligation to provide same-day urgent access has not changed. What the Neighbourhood Health Framework adds is a specific measurable target: 90% of clinically urgent patients seen same-day, by March 2027. Think of it as two stages: the obligation starts April 2026, the measurable target lands March 2027. 2026-27 is your baseline year. If you have been following the readiness sprint plan, you are ahead of the curve. For a full breakdown of what the 90% target means and what to do during the baseline year, see our same-day access update: the 90% target explained.
The framework sets a target of 90% of clinically urgent patients seen on the same day by March 2027. The 2026/27 GP contract already requires same-day access for clinically urgent patients from April 2026, but without a specific percentage threshold. The framework now puts a number on it.
If you have already been working on your same-day access processes since April 2026, you are on the right track. Your work during this baseline year (formalising triage protocols, fixing urgency coding, training staff) is exactly the foundation the 90% target requires. If you have not started, the March 2027 deadline gives you 12 months, but the contractual obligation to provide same-day urgent access is already in effect.
Ensure your clinical system is coding urgency categories correctly so the data reflects what you are actually doing. The 90% target is measured on recorded data, not intent. Practices that are clinically compliant but poorly coded will appear non-compliant.
2. Adopt digital systems with shared care records
The framework expects practices to use Electronic Patient Record (EPR) systems that support shared care records across the neighbourhood. Specifically:
Shared care record access for all INT members working with your patients
NHS App as the default channel for patient messaging and push notifications
Standardised data sharing between neighbourhood services and hospitals
Separately, the NHS has committed to rolling out ambient voice technology and expanding AI-assisted triage pilots to free up clinical time. These are system-level initiatives that will be made available to practices, not mandated requirements with a compliance deadline. If your practice is offered access to ambient voice or AI triage tools, they are worth evaluating, but you are not required to adopt them under this framework.
This does not mean replacing your clinical system. It means ensuring your system can share records with the other professionals in your INT. Speak to your system supplier about shared care record integration and timeline.
3. Implement population health management and risk stratification
The framework expects ICBs to incentivise proactive population health management through risk stratification. In practice, this means your practice will need to:
Using validated tools to stratify your registered population by risk level
Identifying patients in the priority cohorts (see below)
Ensuring 95% of patients with complex needs have agreed, documented care plans by 2027
Risk stratification is not new, but the framework elevates it from good practice to a measurable expectation. Tools like MyPM's risk assessment features can help document and manage the assessment process, though the clinical stratification itself will come from your clinical system and neighbourhood data.
4. Participate in Integrated Neighbourhood Teams
The framework's model depends on GP practices actively participating in their local INT. The specifics will be determined locally, but expect:
Contributing to joint working on priority cohorts
Attending neighbourhood team meetings and governance structures
Sharing relevant patient data with INT colleagues (within information governance requirements)
Supporting co-location of INT staff where appropriate
This is not a paper exercise. INTs are intended to be functioning clinical teams, and your practice's participation will be visible and measurable.
5. Engage with the red tape challenge
The framework includes specific requirements to reduce bureaucratic burden:
Direct prescribing to community pharmacy: Support pathways that allow community pharmacists to prescribe directly for appropriate conditions, reducing GP workload
GIRFT bridging checklist: Implement Getting It Right First Time protocols for planned care referrals
28-day outpatient prescriptions: Outpatient departments to issue 28-day prescriptions (unless clinically inappropriate), reducing the burden on GP practices of issuing prescriptions for hospital-initiated medication
These are practical changes that will require process updates in your practice. Brief your prescribing lead and reception team.
6. Deliver data-led care for complex patients
The framework targets 95% of people with complex needs having an agreed care plan by 2027. This means:
Identifying complex patients through your risk stratification process
Creating or updating care plans that are shared across the INT
Ensuring care plans are reviewed at appropriate intervals
Recording care plan discussions in a format accessible to INT colleagues
If you use a care plan template in your clinical system, check that it is compatible with shared care record standards. If you do not have a systematic care plan process, building one is now a priority.
7. Participate in single points of access for specialist care
The framework requires all providers to establish single points of access starting with at least 10 specialties in 2026-27. Named specialties include gastroenterology, ENT, cardiology, respiratory, diabetes, gynaecology, and urology. This means:
Digital referral pathways that route patients to the right service first time
Reduced back-and-forth between primary and secondary care
More specialist advice available without a full referral
The specifics will depend on your ICB's implementation plan, but expect to be asked to use standardised referral pathways and participate in local triage arrangements for these specialties.
The priority cohorts: who your INT will focus on first
INTs will not try to manage the entire population from day one. The framework defines four national priority cohorts, plus space for locally determined additional groups.
Frailty and end of life
This is the highest-priority cohort. The framework notes that people over 75 living with frailty, those at end of life, and care home residents represent 3-5% of the population but account for more than 25% of non-elective admissions and 50% of bed days. Your INT will:
Identify patients in this cohort using validated frailty scores
Create proactive care plans for high-risk patients
Coordinate with community and social care to prevent avoidable admissions
Provide anticipatory end-of-life care
Practical implication: If your practice does not routinely code frailty scores, start now. This data will be used to measure INT performance.
Multiple long-term conditions
Patients with multiple long-term conditions, particularly cardiovascular disease, diabetes, COPD, and dementia. The INT approach aims to provide coordinated care across conditions rather than siloed disease-specific clinics.
Practical implication: Review how your long-term condition management is structured. If you run separate clinics for diabetes, COPD, and heart failure, the INT model may require a more integrated approach.
Children and young people
The framework targets every child who needs access to an INT having it by 2028-29. This is a later priority but one to plan for, particularly if your practice has a large paediatric population.
Practical implication: Start building relationships with local health visitors, school nurses, and children's mental health services. These will become your INT colleagues.
Cancer
Early detection and support for patients living with and beyond cancer. INTs will coordinate screening uptake, faster diagnosis pathways, and post-treatment follow-up.
Practical implication: Ensure your cancer screening recall systems are robust and your two-week wait referral processes are efficient.
Critical dates and deadlines
Date | Requirement |
|---|---|
April 2026 | Framework implementation begins. Practices expected to start engaging with INT formation. |
September 2026 | Newly qualified pharmacists gain independent prescribing rights, expanding INT pharmacy capacity. |
March 2027 | 90% same-day urgent access target. Single points of access for at least 10 specialties. 95% of complex patients with agreed care plans. |
2028-29 | Every child who needs access to an INT should have it. |
March 2029 | Full implementation. 10% reduction targets across non-elective admissions for frailty cohorts. Clinical outcome improvements across LTCs. |
The March 2027 date is the most operationally significant for practices. It is 12 months away and includes three measurable standards: access, care plans, and specialist referral pathways.
How PCNs are changing
The framework does not abolish PCNs, but it is clear that their role will evolve significantly.
The framework says PCNs "might evolve into SNPs" and commits to consulting on how this would work. In the meantime:
PCN boundaries may shift. HWBs will define neighbourhood geographies. If your PCN does not align with the new boundaries, expect restructuring discussions.
GMS/PMS/APMS contracts are protected. The framework is explicit that core practice contracts remain nationally determined. Your contract is not being handed to your SNP or MNP.
The framework does not specifically address the Clinical Director role or PCN funding mechanics. However, it is reasonable to expect that CD responsibilities will expand to include INT coordination and neighbourhood governance as these structures form. Separately, the 2026/27 GP contract has already shifted CASP/CAIP funding to practice level, which may signal the direction of travel for neighbourhood-level funding.
The most important thing for practice managers to do now is engage with their PCN Clinical Director about INT formation plans. If your CD does not yet have a plan, raise it. If your PCN is in the process of deciding its future structure, make sure your practice's interests are represented.
What this means day-to-day for practice managers
The framework does not spell out day-to-day operational changes for practices. But based on the structures and expectations it introduces, here is what we expect will change in your working week:
New meetings and governance. Expect regular INT meetings, possibly weekly. You will need to coordinate diaries, prepare patient lists, and track actions from neighbourhood-level discussions. This is additional governance overhead, at least initially.
Staff coordination across organisations. INT members from other organisations may be based in or near your practice. You will need to manage room allocation, IT access, information governance arrangements, and potentially line management or supervisory relationships for staff who are not your employees.
Data reporting. The framework introduces neighbourhood-level outcome metrics. Your practice's contribution to these metrics will be visible. Ensure your clinical coding is accurate, particularly for frailty scores, care plans, and urgency categories.
Patient communication. Patients will need to understand what the changes mean for them. Prepare clear information about how neighbourhood teams work, who they might see, and how their care is being coordinated. Your Patient Participation Group (PPG) is a good testing ground for this communication.
Business planning. The framework will affect practice income over time as neighbourhood-level budgets are established. Monitor the consultation on SNP/PCN evolution closely. Engage with your LMC on the financial implications.
Training and development. Multidisciplinary working requires different skills from single-practice management. Consider training in population health management, shared care record systems, and collaborative governance.
Frequently asked questions
Does the Neighbourhood Health Framework replace my practice's GMS/PMS contract?
No. The framework is explicit that GMS, PMS, and APMS contracts remain nationally determined. Your core contract is not changing. The framework adds a neighbourhood layer of coordination and accountability on top of your existing contractual obligations.
Will my practice be merged with other practices?
The framework does not mandate practice mergers. It requires practices to work collaboratively through INTs and potentially through SNP structures that may evolve from PCNs. Your practice retains its identity and its contract. However, the direction of travel is clearly toward greater integration, and practices that cannot or will not collaborate may find themselves increasingly isolated.
What happens if my PCN does not want to become a Single Neighbourhood Provider?
The consultation on PCN-to-SNP evolution has not been published yet. It is expected in 2026. If your PCN decides not to become an SNP, another entity will likely take on that role in your neighbourhood. Your practice would still need to participate in the INT and meet the framework's expectations regardless of who the local SNP is.
How is this different from the NHS 10 Year Health Plan?
The 10 Year Health Plan set out the strategic direction. The Neighbourhood Health Framework is the implementation plan for the neighbourhood and primary care elements of that strategy. Think of the 10 Year Plan as the "what" and the Neighbourhood Health Framework as the "how" and "when."
What should I do this week?
Three things. First, read the framework summary above and brief your partners or practice lead. Second, contact your PCN Clinical Director and ask what plans are being made for INT formation in your area. Third, check that your clinical system is correctly coding frailty scores and urgency categories, as these will be used to measure your contribution to neighbourhood outcomes.
Will there be additional funding to support implementation?
The framework does not announce specific new funding for practices. Implementation is expected to be funded through existing neighbourhood and system-level budgets. Separately, the 2026/27 GP contract has shifted some funding to practice level (replacing PCN-level CASP/CAIP), which may support some implementation costs. Monitor ICB communications for local implementation funding.
How does this affect CQC inspections?
The framework does not explicitly mention CQC. However, the governance, quality, and safety requirements throughout the framework align with CQC's quality statements. Neighbourhood-level outcome data will be visible to CQC, and practices contributing poorly to neighbourhood metrics may attract regulatory attention. Maintaining strong CQC inspection readiness remains important.
What comes next
This is a framework, not finished legislation. Implementation guidance, the PCN-to-SNP consultation, and detailed operational specifications will follow over the coming months. We will publish further analysis as these details emerge, including:
A practical guide to preparing for INT formation
Financial modelling of neighbourhood budget implications for practices
A readiness checklist for the March 2027 targets
In the meantime, the single most important thing you can do is engage early. The practices that shape their neighbourhood structures will fare better than those that have structures imposed on them.
This article is for informational purposes only and reflects understanding as of 17 March 2026. The Neighbourhood Health Framework is a new publication and implementation guidance has not yet been released. Practices should consult with their LMC, ICB, and PCN Clinical Director for local implementation plans and always refer to the latest official guidance from NHS England and DHSC.