Neighbourhood Health Centres: What Practices Need to Know

NHS England published its Neighbourhood Health Centre (NHC) Design and Performance Specification in April 2026 as part of the government’s wider neighbourhood health agenda. These documents provide a clearer indication of how neighbourhood healthcare may operate in the future and raise a number of important questions for GP practices.

NHCs are intended to bring together GP practices, community health services, social care, mental health, and other services within shared facilities serving populations of around 50,000, broadly aligned with PCN footprints. General practice is expected to be a core component of the model, with centres operating extended opening hours and supporting more integrated, multidisciplinary care. Areas with the lowest healthy life expectancy will be prioritised for early investment.

One of the most significant aspects of the NHC model is its approach to premises.

The Design and Performance Specification envisages highly utilised buildings where space is shared between multiple users rather than allocated exclusively to individual providers. The emphasis is on a flexible use of clinical and non-clinical space, supported by digital booking systems and coordinated management arrangements.

For practices accustomed to occupying their own surgery premises, whether owned or leased, this represents a significant cultural and operational shift. Questions immediately arise around who controls the building, who allocates space, how occupation costs are shared, and how disputes between different users are resolved.

However, the existing Premises Cost Directions 2024 support traditional ownership and lease arrangements, raising questions about how these will apply in shared occupancy models.

The NHC model raises immediate questions for partnership governance.
Partnership deeds typically vest decision-making authority over premises with the partners. However, the NHC model – with its emphasis on co-location with multiple services and extended opening hours- raises questions about how practices will exercise that authority.
Practices will need to consider whether their existing partnership agreements remain fit for purpose.

For example:

• Who will make decisions about premises matters on behalf of the practice?
• What authority will partners have to enter into new occupancy arrangements?
• What happens if partners disagree about participation in a neighbourhood model?
• How will partner exits and retirements be managed where premises arrangements become more complex?

These are issues many existing partnership agreements were never designed to address.

The NHC model seeks to promote greater collaboration and integration between providers. Whilst this may create opportunities, practices will understandably want to understand how much control they retain over their day-to-day operations.

The guidance leaves a number of practical questions unanswered, including:

• Who controls room allocation?
• How are competing demands for space managed?
• Who determines opening arrangements within the building?
• What governance structures oversee the operation of the centre?
• What influence will individual practices have over future changes?

Practices should take care to understand how these arrangements will work in practice before committing to any new model.

Whilst much of the focus is naturally on the risks and uncertainties, neighbourhood health centres may also present opportunities.

For some practices, NHCs could provide access to improved premises, upgraded technology and infrastructure that would be difficult to achieve independently. The model may also support closer working with community and specialist services, potentially improving patient experience and clinical pathways.

Practices struggling with ageing premises may also see neighbourhood developments as an opportunity to address longstanding estate challenges.

The extent to which these benefits are realised is likely to depend heavily on local implementation and the arrangements put in place within individual centres.

Given the pace at which the NHC programme is moving, practices should take immediate steps.

1. Review your existing lease and premises arrangements – understand your current obligations, break clauses, and options should your practice be identified for NHC consolidation.
2. Review your partnership deed – consider if your existing governance arrangements adequately deal with the type of decisions that will arise in shared occupancy environments.
3. Engage with your PCN and local stakeholders – NHCs are likely to develop differently from area to area. Early engagement may help practices better understand local proposals and influence how they evolve.

A practice should always seek specialist guidance given the fundamental impact these changes will have on primary care. If you would like to discuss how this guidance applies to your practice, then get in touch here.

by Sarah Cook

Legal Director