Neighbourhood working:
Emerging NHS models and lessons from international exemplars
The government’s Fit for the Future: 10 Year Plan for Health in England represents a defining moment, articulating a vision that moves decisively beyond the 20th-century model of a hospital-centric system. At the heart of this future is the creation of a dedicated "Neighbourhood Health Service," designed
to be more responsive, proactive, and closer to people's homes.
This report offers our analysis of the three emerging structural archetypes for neighbourhood working that we see taking shape across the country - GP-led, Community/Mental Health-led, and Acute-led. We examine the pros and cons of each, supported by case studies from pioneers in England and around the world.
Three distinct emerging structural archetypes:
- GP-led: Models built from the ground up by primary care, often evolving from Primary Care Networks (PCNs) or federations, characterised by agility and deep community roots.
- Community or Mental Health-led: Models driven by community or mental health trusts, leveraging their expertise in out-of-hospital care and strong links with social care.
- Acute-led (Integrated Healthcare Organisation): A model of vertical integration where a hospital trust takes a leading role in organising services across the full care pathway.
International exemplars
Ribera Salud (Valencia, Spain)
The "Alzira model," pioneered by the Ribera Salud group in Valencia, is a radical example of a fully integrated public-private partnership that aligns financial incentives around population health.
Under the Alzira model, a single private provider is given a long-term contract and a fixed annual capitation payment for every person living in a defined geographical area. In return, the provider is responsible for delivering the full range of primary, secondary, and specialist care for that entire population. The provider only makes a surplus if it can keep its population healthy and out of expensive hospital settings. This creates a powerful, built-in incentive for prevention, efficiency, and integration. The model is underpinned by a unified digital system that provides a shared patient record across all services
Cityblock (New York, USA)
Cityblock Health is a US-based care organisation reimagining how healthcare is delivered to people with complex medical, behavioural, and social needs. Founded in New York in 2017, Cityblock combines local “community hubs” with a powerful digital platform that connects clinicians, care coordinators, and social workers around each person’s needs. Its model focuses on proactive, personalised care - supporting people in their homes and communities rather than hospitals.
Cityblock operates on a value-based, capitated payment model, meaning it is rewarded for improving outcomes and reducing avoidable hospital use. The result is a holistic, data-driven approach that delivers better health, greater equity, and a more human experience of care.