NHS PLAN
diagnostics, rehabilitation, and social care, can be delivered more effectively closer to home. Neighbourhood based models enable:
1. Integrated multidisciplinary teams working in one place. 2. Earlier access to diagnostics. 3. Joined up care across primary, community, mental health, and voluntary sectors.
4. Reduced pressure on emergency departments and acute beds.
5. Improved continuity and personalised support. 6. More equitable access for communities with the greatest need.
For example, many systems are creating neighbourhood hubs where physiotherapists, mental health practitioners, GPs, social prescribers, and community nurses work in one location. Patients who previously relied on multiple hospital appointments can now receive assessment, diagnostics and follow up in a single local visit, improving access and reducing acute pressure. Several ICSs we support are finding that community
provision has not grown at the pace required to absorb displaced acute activity. Estates teams often highlight that existing community buildings lack the clinical adjacencies, diagnostic capacity, or digital infrastructure required to support neighbourhood models. This has driven programmes focused on repurposing under-utilised estate, co-locating multidisciplinary teams, and prioritising community diagnostics to create viable alternatives to hospital-based care. The Plan encouraged this shift, but today the momentum is driven by ICSs and DHSC programmes that recognise neighbourhood capacity as the foundation for relieving acute demand.
Shift 2 Reactive to preventative – moving from treating illness to building population health Prevention, proactive management of long-term conditions, anticipatory care, and positive health education are now essential to long-term sustainability. This shift includes: 1. Earlier diagnosis. 2. Risk stratification and targeted intervention. 3. Community diagnostic access. 4. Behaviour change and health education. 5. Integrated support across agencies. 6. Coordinated long-term condition management. 7. Rehabilitation and wellbeing programmes. 8. Personalised anticipatory care.
The upstream model is now becoming real. Many systems
are co-locating community diagnostics, wellbeing services, and long-term condition support within neighbourhood hubs, enabling earlier assessment and intervention in a single visit. This reduces acute escalation and improves access for high need populations. Clients consistently highlight that prevention is less
constrained by clinical intent than by infrastructure. Many Trusts and ICSs report that while population health strategies are well defined, existing estate and capital pipelines are still configured for episodic, acute-led delivery. As a result, systems are increasingly re-prioritising capital investment toward CDCs, flexible wellbeing spaces, and digitally enabled hubs that support earlier intervention and proactive condition management.
Shift 3
Analogue to digital – building a digitally connected health system The shift from analogue to digital is the most transformative and the most challenging. It requires estates, workforce, pathways, and data systems to function as a single ecosystem. Digitally enabled care includes: 1. Virtual consultations. 2. Remote monitoring. 3. Shared care records. 4. AI-supported diagnostics. 5. Digital MDT working. 6. Predictive analytics. 7. Seamless data flow across care settings.
This shift is not about adding digital tools to old workflows. It requires redesigning clinical pathways for a digital- first system. For example, some systems have rebuilt the musculoskeletal pathway so patients begin with a digital triage and self-assessment, followed by a virtual consultation and then an in-person appointment only when necessary. This redesign changes referral processes, clinical workflows, and workforce deployment, and depends on integrated digital platforms. The Plan anticipated this and the most advanced
systems are embedding digital design into estates and service planning from the outset. In practice, clients often describe digital transformation
as the most complex shift to deliver. Estates and digital strategies are frequently developed in parallel rather than together, leading to misalignment between physical infrastructure and digital pathways. Several organisations raise concerns that capital schemes risk embedding legacy models of care if digital requirements are not defined early, particularly for diagnostics, outpatient, and long-term condition pathways.
September 2026 Health Estate Journal 27
Above left: Houghton Primary Care Centre.
Above: South Tyneside and Sunderland Integrated Diagnostic Centre.
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