The Neighbourhood Health Framework: Five Goals PCN Leaders Need to Understand
- 3 days ago
- 5 min read
Updated: 2 days ago
NHS England published neighbourhood health guidelines in January 2025. They set out the rationale, the population cohorts to focus on, and six core components for systems to standardise and scale. Systems were asked to agree locally what impacts they would seek, with regional teams supporting that process.
The Neighbourhood Health Framework, published on 17 March 2026, is a different kind of document.
It moves neighbourhood health from guideline to requirement. Where the 2025 guidelines provided a framework for local action, the 2026 Framework replaces that with named national targets, a formal delivery architecture, and a structured planning timeline.
For PCN leadership teams, the most immediately relevant section is the five national goals, each with specific metrics and timescales running to March 2029. This blog summarises those goals and should be read alongside our analysis of Fit for the Future [link], which sets out the contract architecture that sits underneath the Framework.
What changed between January 2025 and March 2026?
The clinical logic of neighbourhood health did not change. The same cohorts; people with frailty, care home residents, housebound patients, those approaching end of life, people with multiple long-term conditions, children and young people were already named in the 2025 guidelines.
The three shifts (hospital-to-community, treatment-to-prevention, analogue-to-digital) were already established.
What the Framework adds is structure. The six core components of the 2025 guidelines are now organised within a formal delivery architecture: three reform agendas, five national goals, a two-stage implementation timeline, and new population-based contracts.
ICBs and local authorities are no longer just asked to jointly plan; they are required to do so through Health and Wellbeing Boards, with neighbourhood health plans in place for 2027/28.
For PCN leaders, the shift matters because it changes what ICBs will be tracking and, in time, what they will be commissioning against.
Goal 1: Improve health outcomes
The Framework identifies specific high-priority cohorts: people with frailty, care home residents, housebound patients, those receiving end of life care, and people with CVD, diabetes, COPD, dementia and mental health conditions. Children and young people are also included.
The metrics are:
A 10% reduction in non-elective admissions and bed days for people with mid to severe frailty, care home residents and housebound patients by March 2029
A 10% increase in the number of people identified as approaching the end of life, and a 10% reduction in non-elective admissions for that cohort, by March 2029
A 10% improvement in evidence-based clinical outcomes measured through QOF standards for CVD, diabetes, COPD, mental health conditions and dementia by March 2029
A 10% increase in patients with diabetes receiving all eight elements of the care process bundle
A 10% reduction in acute outpatient appointments for children under 16 by March 2029
INTs should initially focus on the frailty and end of life cohorts, with multiple long-term conditions and children and young people as subsequent priorities. Some metrics are still being developed, with details to follow through the planning round.
Goal 2: Improve access to general practice
The Framework describes general practice as the bedrock of neighbourhood health and sets one specific near-term target: 90% of clinically urgent patients seen on the same day by March 2027.
For routine access and patient satisfaction, 2026/27 is a baselining year. ICBs may set local goals in agreement with contractors in the interim, with national trajectories to follow.
The Framework also names a wider set of actions to support access: GP direct access to diagnostics, AI and ambient voice technology, expanded online consultation tools through the NHS App, reform of out-of-hours services, and the Red Tape Challenge, a range of primary and secondary care interface improvements.
The shape of routine access targets from 2027/28 onwards will be determined through local conversations with ICBs.
Goal 3: Improve the experience of planned care
This goal focuses on reducing variation in referrals to outpatient services and improving coordination for people with multiple conditions.
The metrics are:
A diversion rate of at least 25% by March 2027 for at least 10 high-volume specialties, through a single point of access (SPoA) and multidisciplinary team models
A contribution to RTT trajectories of 70% by March 2027 and 92% by March 2029
A 10% reduction in secondary care follow-up appointments by March 2027, with more follow-up care delivered in neighbourhood settings
The Framework names the specialities to prioritise: gastroenterology, ENT, cardiology, respiratory medicine, diabetes, gynaecology, and urology. GPs will work more closely with specialists through single-point-of-access arrangements, with follow-up care progressively moving into community settings.
Goal 4: Better urgent and emergency care performance
Goal 4 addresses demand on urgent and emergency care services, with neighbourhood-level interventions intended to reduce avoidable attendances and admissions for high-priority cohorts.
The metrics are:
Keeping growth flat and working towards an overall reduction in non-elective admissions for high-priority cohorts
Contributing to type 1 ED 4-hour performance of 82% by March 2027 and 85% by March 2029
Reducing category 3 and 4 ambulance conveyances for high-priority cohorts by March 2029
Improving the average length of discharge delay for all acute adult patients
Expanded urgent community response services, increased virtual ward capacity and greater intermediate care capacity are named as the main delivery mechanisms, with the frailty, care home and housebound cohort as the primary focus.
Goal 5: Improve patient and staff satisfaction
The Framework sets out intentions to reform how patient experience is measured and to introduce neighbourhood staff experience measures. Both will be introduced in 2026/27 with annual improvement trajectories. Detailed metrics are to be confirmed.
One specific commitment with a defined date: by 2027, 95% of people with complex needs will have an agreed care plan.
What remains open
Several metrics are still being developed, with details to follow through the planning round.
The consultation on how the PCN DES, GMS, SNPs and MNPs will work together, including how PCNs might evolve into SNPs, is referenced in the Framework but has not yet begun.
What the Framework asks of PCNs directly in 2026/27 sits largely within existing responsibilities: INT development and GP access improvement. The broader contractual picture, including the future of the PCN DES in relation to the new provider architecture, remains subject to the consultations still to come.
What to read alongside this
The Neighbourhood Health Framework should be read alongside Fit for the Future, found here: https://www.thcprimarycare.co.uk/post/fit-for-the-future-published-what-pcn-leaders-need-to-know, which sets out the SNP, MNP and IHO contract architecture that will underpin neighbourhood health delivery.
We hope this helps
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