The UK Government's commitment to deliver up to 250 neighbourhood health centres (NHCs) – with about 120 expected by 2030 – is one of the most tangible expressions of the NHS's shifts from hospital to community and from treatment to prevention.

Over the past few weeks, two of the most significant events in the healthcare and infrastructure calendar – UKREiiF in Leeds and NHS ConfedExpo in Manchester – have brought together NHS leaders, investors, developers and clinicians to work through what this commitment actually requires. 

Speakers across numerous panel sessions were frank about both the opportunity and the scale of the challenge. They also discussed the complex jigsaw in which how NHCs will be delivered via existing estate and purpose-built facilities, as well as the funding mechanisms behind these such as modern public-private partnership (PPP) models.

This article draws out the themes that emerged most clearly across both events.

What is an NHC and why does clarity matter?

Before getting to delivery, it is worth being clear about what an NHC actually is because, as several speakers noted, the term risks becoming another piece of health jargon that means both everything and nothing.

At its most straightforward, an NHC is a place that communities see as their first port of call for most health needs. 

It brings together general practice with community health, local authority and voluntary sector services, operating at a minimum of 12 hours a day, six days a week. The non-negotiable core includes GP services, community health and integrated neighbourhood teams, mental health provision, and support for babies, children and families. 

Around that core services such as diagnostics, urgent treatment, specialist clinics and wider community support – debt advice, employment support and healthy living hubs – can be configured to reflect local need.

This flexibility is deliberate and has the potential to deliver effectively for communities. An NHC in a rural Cumbrian market town looks different from one in inner-city Manchester. But that flexibility must sit alongside clarity for the public about what they can expect, as well as for commissioners, developers and investors about what they are actually building and delivering.

Ollie Clarke, Director of Capital at NHS England, said at ConfedExpo: “If all we achieve is taking a set of existing services and putting them in the same building, we will not have delivered the agenda. The goal is to integrate care around the patient – not co-location as an end in itself.”

Making the most of what already exists

One of the most important signals from both events was the emphasis on existing estate. While the instinct is to focus on new buildings, NHS England's guidance on NHCs is clear that opportunities to reuse, repurpose or upgrade existing estate should be fully explored before new-build solutions are proposed.

The archetypes being developed reflect this. Hub-and-spoke models that link refurbished or extended facilities with distributed local services offer a practical route in many areas. Civic and community spaces – high streets, libraries, leisure centres – offer another. 

Cohort-specific hubs, such as women's health centres and family hubs, can be developed into full NHC provision where the infrastructure already exists. New, purpose-built centres are reserved for places where existing provision genuinely cannot serve the purpose.

This matters not just for cost, but for community resonance. As Sarah Beaumont-Smith, Chair of the Neighbourhood Health Forum, observed, buildings at the heart of communities are part of the ambition. But those buildings must be run by those meaningfully engaging with users on a daily basis. Those running the provision must be factored into the overall cost as NHC is ultimately a community centre, and the human infrastructure is as important as the physical.

At UKREiiF, the conversation about existing estate also drew in decarbonisation – a dimension that is sometimes treated as a separate agenda but in practice runs through every estate decision. 

The design standards being developed for NHCs require that both operational and embodied carbon are considered from the outset. Retrofitting existing buildings must be informed by good data. New-builds should have resilience built in, including on-site renewable generation and integration into heat networks where available. 

As Kelly Crews, Head of Decarbonisation Service at of Willmott Dixon, noted, the art of the possible here has expanded significantly. She said the lessons from BREEAM Excellent standards being successfully applied in recent years show what can happen when the industry is given clear expectations and the time to meet them.

Funding: The angel cake model and the return of PPPs

The funding picture is where the complexity intensifies, and where both events generated the most substantive discussion.

A useful framing was offered at ConfedExpo by Alistair Rose, Director of Strategic Estates, Infrastructure and Sustainability at NHS Lancashire and South Cumbria ICB. He suggested thinking of NHC funding as an angel cake, with money coming in three distinct layers – existing NHS capital funding streams, investment from wider public asset bases and a new PPP model for new builds.

For an ICB trying to navigate this, the task is to be very clear about which layer is doing what, and to ensure all three are in place before schemes are presented as ready to progress.

The PPP element may be the most novel and consequential. Private finance is expected to fund about 80% of new-build NHCs. The government is developing a new PPP model and planning formal market engagement later this year. 

The logic is clear: PPPs allow the programme to move beyond the capital constraints that would otherwise make delivery at this scale nigh-on impossible. The trade-off is a revenue commitment through a unitary charge repaid over time. As Ollie Clarke acknowledged at ConfedExpo, creating this structure is no mean feat when you are trying to bring together existing funding streams and seeking to realise the financial benefits that flow from the shift away from acute care.

The history of previous PPP models in healthcare was addressed directly and honestly at UKREiiF. The private finance initiative (PFI) received criticism for its perceived drawbacks such as poor risk transfer, transparency and long-term value for the public sector. 

However Kevin Hawkins, Operations Director and Head of Social Infrastructure at Kajima Partnerships, made the case that PFI delivered more than 160 hospitals that remain in good condition. He said England's moratorium on PPP since 2018 has left it as an outlier while 1,000-plus PPP projects have been delivered globally in the same period. 

The principles of risk transfer and cost certainty have not changed. What has evolved, in models like the Welsh mutual investment model and Scotland’s non-profit distributing model, is greater transparency, better baked-in social value commitments, and a more sophisticated approach to risk allocation. 

The fashionable negativity about PFI, several speakers argued, has obscured what was genuinely achieved and delayed a conversation on modern PPPs that the NHS urgently needs to have.

Standardisation, pipeline and pace

One of the sharpest tensions in discussions at both events was between the competing needs for local flexibility on the one hand, and standardisation at scale on the other. With 120 centres by 2030 an ambitious target, the programme needs to deliver at pace and this requires a credible, well-understood pipeline that the market can respond to. 

Simon Corben, Director and Head of Property Profession at NHS England, told his UKREiiF audience the market will respond where it sees what to expect. The schools building programme, cited by several speakers, showed what happens when public sector procurement is sufficiently professionalised and pipelined that the bidding market has confidence.

Standardisation in design – pre-designed solutions adaptable to local context – can bring schemes forward more quickly and reduce the reinvention that has historically driven up costs and timetables. The challenge, as Ollie Clarke acknowledged, is balancing that standardisation with the genuine local variation that neighbourhood health demands. NHCs are not all the same. But the core design principles, procurement structures and legal frameworks can and should be common.

The submission and prioritisation process now underway – regional and national review, challenge and moderation, followed by scheme refinement and business case development – is designed to build that pipeline. Initial approvals are expected over the summer. 

What matters most at this stage is that ICBs approach this with clear thinking on three things: 

• System planning: which services and which providers will anchor the NHC.
• Transition planning: how services move and integrate.
• Delivery planning: why this scheme is ready to progress now. 

As Rose put it, you need the whole cake, and you need to be honest about which layers are genuinely in place.

Leadership, governance and the operating model

Several voices at both events raised a concern that the risk in this programme is not the build, but the service model. 

A building can be built on time and on budget, yet still fail to deliver neighbourhood health if the incentives, governance and leadership arrangements are not in place to make integration happen.

The leadership challenge is significant. ICBs are under considerable pressure – reduced in number, navigating NHS transformation, and now being asked to lead a major estates programme simultaneously. 

Governance arrangements need to be proportionate and clear, with shared accountability between the NHS, local authorities and the voluntary sector. 

The operating model that covers who runs the facility, on what terms and with what incentives to serve the intended population, rather than default back to acute-centred thinking, needs to be thought through alongside the estates decision, not after it.

The question of GP tenancy models, raised at UKREiiF, is a practical illustration of the wider point. 

Many buildings will not be used to having a GP as a tenant. The licence and tenancy structures need to be designed to drive higher utilisation and flexibility, not to create rigidities that undermine the NHC's core purpose. Scotland's hub programme, with its head tenant model and flexible licence arrangements, was cited as a model worth examining.

Our view

The neighbourhood health centre programme is one of the most significant infrastructure opportunities in the health sector in a generation. 

At Browne Jacobson, we recently published a joint report with the CBI, Pipeline to Progress: Making UK infrastructure investable, which sets out a comprehensive blueprint for reforming the UK's PPP framework. 

Its conclusions are directly applicable to the NHC programme. The report identifies six reform pillars essential to making PPP work in the current environment: 

• a standardised national legal architecture.
• proportionate risk allocation.
• auditable social value embedded in contracts.
• flexible financial structures scaled to project maturity.
• stronger governance and institutional memory.
• a clear, credible delivery pipeline. 

These are not abstract policy ambitions, but the practical building blocks that will determine whether the market responds to NHS England's forthcoming PPP model engagement with the confidence and ambition the programme needs.

The report is unambiguous: financing is not the binding constraint – there is genuine appetite from institutional capital to support UK infrastructure where risk is balanced, pipelines are credible and contracting is agile. 

What is constrained is priceable, patient capital aligned to delivery risk and pipeline certainty. The NHC programme, if structured well, can offer exactly that.

What this means in practice for NHCs is that the legal and commercial design of these schemes matters enormously – from the tenancy and licence structures that govern how services occupy buildings, to the contract frameworks that govern PPP arrangements, and the governance models that hold multi-organisational partnerships together over time. 

Getting these right from the outset is not a compliance exercise. It is the foundation on which successful delivery of the neighbourhood health centre programme depends.