When the Department of Health and Social Care published the Neighbourhood Health Framework on 17 March 2026, it marked the formal start of the biggest structural shift in NHS care delivery in over a decade. Integrated Care Boards are now in the middle of Stage 1 implementation – agreeing neighbourhood footprints, establishing Integrated Neighbourhood Teams for high-priority cohorts, and planning how referral pathways will work when care is increasingly delivered by multidisciplinary teams in the community.
This isn't an aspiration for 2030. It's a transformation underway in 2026/27. And while much of the conversation has focused on workforce models, estate planning, and commissioning arrangements, there's a question that hasn't received nearly enough attention: what happens to referrals when the destination changes?
The core principle of neighbourhood health is straightforward: care should happen as locally as it can. Digitally by default, in a patient's home, if possible, in a neighbourhood health centre when needed, in a hospital if necessary.
For patients with complex needs – frailty, long-term conditions, end-of-life care, mental health – this means a shift away from repeated hospital appointments towards proactive management by Integrated Neighbourhood Teams, bringing together GPs, community nurses, therapists, social care professionals, and specialists. By 2027, 95% of people with complex needs should have an agreed care plan managed at neighbourhood level.
For elective care, the framework introduces single points of access for at least 10 high-volume specialties – gastroenterology, ENT, cardiology, respiratory, diabetes, gynaecology, and urology among them. Hospital clinicians will remotely review referrals and decide whether to arrange a specialist appointment, provide written advice, or redirect the patient. The target: 25% of referrals diverted by 2027.
GPs already refer into community services – MSK teams, district nursing, mental health support, diabetes clinics. Those pathways exist, and they work. The challenge isn't that neighbourhood health invents community referrals. It's that it fundamentally changes their scope and integration.
Previously, community referrals were largely single-service: refer to MSK, refer to district nursing, refer to mental health. Neighbourhood health brings these together under Integrated Neighbourhood Teams with accountability for managing complex patients across multiple conditions. A patient with diabetes, heart failure, and frailty isn't referred to three separate services anymore – they're managed holistically by a team that coordinates all their care.
That changes the referral dynamic completely. When an Integrated Neighbourhood Team is managing a patient with multiple long-term conditions, who initiates the referral for a new symptom? When a single point of access can redirect a patient to community diagnostics, a virtual ward, or specialist support embedded in a neighbourhood team, how does the referrer know which option is most appropriate? When care budgets are devolved to neighbourhood level, how do referral pathways account for services that didn't exist six months ago?
The framework sets ambitious targets – 78% of community health service activity within 18 weeks by the end of 2026/27, rising to 80% by 2028/29, with all 52-week waits eliminated. But hitting those targets depends on referrals supporting integrated teams, not just routing patients to individual services.
If referrals continue to treat community pathways as separate, single-service routes while care delivery shifts to integrated neighbourhood teams managing complex cohorts, the result is predictable: fragmented information, patients managed in silos when they need coordinated care, delays while teams piece together context from multiple sources, and neighbourhood teams unable to demonstrate the outcomes they've been commissioned to deliver.
The principles haven't changed – right patient, right service, right information. What's changed is the complexity of what "right service" means when community services are integrated rather than fragmented.
In a neighbourhood health system, referral pathways need to:
The neighbourhood health framework is explicit that 2026/27 is a developmental year. ICBs are agreeing geographies, establishing teams, confirming data-sharing arrangements, and working out how the new models will operate in practice. That's appropriate – this is complex, system-wide change that needs to be done properly.
But referral pathways can't wait for everything else to be finalised. Referrals are happening today, and they need to work in the system as it exists now while also being fit for the system that's being built. That means referral processes that can adapt as neighbourhood services come online, clear guidance for referrers on when to use new pathways, structured data that supports both traditional hospital triage and new single points of access, and integration with the shared care records that Integrated Neighbourhood Teams rely on.
The framework sets the direction. The question for systems implementing it is whether their referral infrastructure can support the shift.
Getting the basics right isn't optional. It's essential – and it's needed now.
Interested in how referral pathways can support neighbourhood health implementation? Get in touch – hello@dxs-systems.co.uk
