Neighbourhood centres expected to include ‘on-site general practice’, says NHS England
New neighbourhood health centres planned by the Government will be expected to include ‘on-site general practice’ as a ‘core element’ of the model, not solely GP staff or sessional input, NHS England has said in new guidance.
The Government has committed to opening 250 ‘one stop shop’ neighbourhood health centres (NHCs) which underpin the neighbourhood health service contracts announced last year as part of the NHS 10-year plan.
Now in new guidance for ICBs, NHS England said that these will be ‘anchored around general practice’.
ICBs will be agreeing the geography (‘a neighbourhood’) around which services should be delivered, and should plan for neighbourhood health centres to serve a population footprint – around 50,000 people, the scale of a PCN – with ‘general practice at the core’.
The guidance also laid out four ‘archetypes’ (see box), which outline the differences between those centres to be created from the existing NHS or local authority estate, and those to be newly built.
NHS England also asked commissioners to identify the model or combination of models ‘best suited’ to each neighbourhood.
Where there is ‘high-quality existing estate’ such as GP premises in a neighbourhood area, the ‘hub-and-spoke’ archetype is the ‘quickest and most affordable route’, the guidance said.
NHS England’s definition of neighbourhood health centres
What is a neighbourhood health centre?
NHCs bring together GP practices and a mix of community, local authority, adult social care and civil society services, allowing staff to deliver more co-ordinated and effective care for better patient outcomes and experiences.
Centres will be expected to:
- meet the expectation set out in the 10 Year Health Plan to be open at least 12 hours a day and 6 days a week providing access to coordinated services locally.
- include on-site general practice as a core element of the model, not solely GP staff or sessional input.
Source: NHS England
Another piece of guidance published at the same time also set out that in addition to ‘core’ centres there will also be two other types of centres including more services:
- ‘Core+ centres’ include additional space for services such as family support and healthy child
development, primary care‑led mental health provision and minor injuries or walk‑in services; - ‘Core++’ centres also include diagnostic space and 24‑hour phlebotomy provision, supporting
local need and, where appropriate, acute services.
The guidance also set out how many patients they should serve:
- 30,000 general practice population (core)
- 50,000 community care population (core+)
- 100,000 ‘other’ for example diagnostic (core++)
And other assumptions on how the space should be utilised:
- rooms are shared between services on a timetabled basis delivering an integrated
service model - all services operating at 80% utilisation of spaces
- open 6 days a week.
- open 12 hours
- spaces out of hours available for community activities
The first ‘wave’ of 27 neighbourhood health centres confirmed by the Government, which will open in 2027, align with the first archetype.
Of the neighbourhood health centres that come under archetype four – new, purpose-built centres – 80% of them will be funded through public-private partnerships (PPP), a form of private finance.
Neighbourhood health centre ‘archetypes’
Archetype 1: Hub-and-spoke and upgrading, repurposing or extending existing NHS estate
Upgrading or reconfiguring existing GP, community or other NHS buildings, often complemented by ‘spokes’ such as mobile units or small satellite sites. This is typically the quickest and most affordable route to creating an NHC and is appropriate where there is high-quality existing estate that can be extended to provide the right neighbourhood health service offer.
Archetype 2: Repurposing community or civic spaces
Across the NHS, local government, the wider public sector and civil society, there is already substantial estate that can be used to host neighbourhood health services. Some high street premises, libraries, leisure centres or other civic assets may be suitable for adaptation to host neighbourhood health services. This brings care closer to people’s homes and can be delivered at pace and comparatively low cost. These facilities often will not be able to provide the full range of services expected from a NHC, but they can form a valuable part of the local offer.
Archetype 3: Cohort-specific hubs
Existing hubs that provide health or care services in the local community for particular groups, such as women’s health hubs, Best Start Family Hubs for children and young people, community based mental health centres or respiratory hubs can be integrated into the wider neighbourhood health offer. These hubs will not always be physically located within an NHC, but should complement, align with and, where it makes sense locally, be co-located or consolidated with NHCs.
Archetype 4: Purpose-built neighbourhood health centres
New-build centres designed specifically for co-located services and multidisciplinary teams (see the NHC design specification for the detail). These will be delivered through a mix of public capital and a new PPP model in areas where current estate cannot readily be repurposed to deliver convenient access for patients to the full range of neighbourhood health services.
Source: NHS England
The guidance revealed that PPP schemes will likely be procured ‘in batches of 5 to 10 projects’, rather than as individual schemes.
Because of this, the Government requires ‘clear early understanding’ of the future pipeline of new build projects within an area over time from commissioners, meaning ICBs will need to develop ‘detailed business cases’ for inclusion in the PPP programme further in advance than for other archetypes.
A new Neighbourhood Estates Investment Committee to ‘provide assurance in line with HM Treasury Green Book principles’ will oversee approval for these PPP applications, the guidance said.
The BMA has previously urged the Government not to build NHCs using private finance because of ‘historic poor value for money and service offered by these arrangements’.
Around 130 NHS schemes were funded by the Private Finance Initiative (PFI), another form of private finance, until 2018 and are expected to ultimately cost more than £80bn in repayments, with the model criticised for its inflexibility and perceived value for money.
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READERS' COMMENTS [8]
Please note, only GPs are permitted to add comments to articles
Yet again showing that they have missed the point. The evidence very clearly says that the only model that will deliver better health outcomes cost effectively is by increased investment in primary care medical services – ie general practices. The neighbourhood agenda will only deliver an improved health service if based upon general practices which have premises fit for purpose and increased non-micro-managed funding with wrap around community services that support and are answerable to the general practices. Anything else will result in yet another failed and costly try at reorganisation.
Another harebrained plan, don’t have budget, any f then out pops political manager plus sold doctors plan, where did the money come from? The “failed system” from twenty years back was better than this hodge podge share the loot plans that followed with the NHS going downhill all the time, well hang few ng feet hmm at the bottom for ten years now.
Too many incompetent self serving professionals too in every form of general practice.
I would rather metal health, general practice, community services all had extra money to do their core job than waste it all on buildings whilst starving the funding for staff to do the actual job. About 50% of GP work is generated by other services adopting a transactional and obstructive approach to their work presumably as a result of shortage of funding for staff.
Unfortunately all the comments are true and also untrue. Our poorer deprived areas have greatest need yet fewest GPs because they are undervalued and overworked. These centres are for these areas (as Labour have said ) not the leafy suburbs.. it must be in teams of all skills, including council staff and health staff plus family life mentors etc. Refer to Professor Marmot and the Black Report if in doubt and accept this is new resources for the areas that need it most- that’s why the GP committees are upset- no one is represented on it from the hardest working GPs but if it works their working lives will be transformed and the health of those that deserve it most.
Hands up who’s booking a 3am appointment in the 24 hour phlebotomy service.
Yet another reorganisation where money is wasted on change rather than properly funding what is there and works. Will not work at all for rural areas. Using PFI is madness as it’s repeatedly proven to be very poor value. Only PFI companies will benefit from this… I bet they have an army of well paid lobbyists.
Appreciate it’s not the only concern but how will 24 hr phlebotomy help anyone?