Commissioning a 'neighbourhood health service': what can we learn from the literature?

The recently published NHS 10 Year Health Plan1 envisages an NHS built around ‘neighbourhood health services’, with a significant rebalancing of investment and spending away from hospitals to services delivered in local communities. The plan is clear that each area will be free to develop its own service model, but a number of elements are highlighted as being important. These include:

- neighbourhood health teams, providing integrated care across defined geographical areas;

- better GP access, including digital access and the potential for more primary care to be delivered at scale;

- care plans for those with multiple long-term conditions;

- expanded access to personal health budgets; and

- new neighbourhood health entres, housing a range of services in a single building.

Many of these things currently exist in many areas, but the plan highlights the need for a more consistent and comprehensive approach across England. In delivering these things, the plan sets out a structure that includes a leaner and less directive centre (bringing together the functions of the Department of Health and Social Care and NHS England), seven regional teams, and a smaller number of reconfigured Integrated Care Boards (ICBs), with their geographical footprints adjusted as necessary to better match local authority boundaries. Importantly, the role of ICBs as commissioners of care is reiterated, with a renewed focus on taking a strategic approach to commissioning care from a market of providers and with boards reconfigured to remove provider representatives. The plan also references the creation of new forms of contract, by which ICBs may contract with either a single neighbourhood provider (assumed to correspond to the footprint of a single Primary Care Network) or a multiple neighbourhood provider to deliver the required neighbourhood services.

There is clearly much to be clarified about the components of the envisaged neighbourhood care, as well as their delivery in practice. However, our focus in this article is upon the commissioning process. Given the strong focus within the plan upon the role of ICBs in shaping the market of local neighbourhood providers, we provide an evidence-informed commentary on what infrastructure and local processes are likely to be necessary to support the changes. We argue that, without attention to who sets local goals, how commissioning decisions are made, available mechanisms for allocating resources, and approaches to oversight and monitoring, the difficult task of breaking down barriers between sectors and organisations cannot be achieved. Without effective commissioning infrastructure it is unlikely that the new service models will be effectively delivered.

To explore what might be required to commission a ‘neighbourhood health service’, we examined two broad literatures: evidence related to commissioning; and the evidence around the implementation of integrated care initiatives. This was not a systematic review; rather, in both literatures we focused upon significant review articles to answer the question: what local processes and structures are required if integrated care systems are to effectively commission integrated neighbourhood services?