In its new ‘RCP View on neighbourhood health’ report, the Royal College of Physicians (RCP) sets out a vision for the role of medical specialists in neighbourhood-based care as it’s revealed nearly half (48%) of physicians report being unclear about how their role would function within a neighbourhood health team.
Urgent clarity is needed on the role of medical specialists in neighbourhood-based care to avoid patients continuing to experience fragmentation between services and professionals, says the RCP.
The RCP welcomed 10 Year Health Plan commitments to reform outpatient – or ‘planned specialist’ – care and the shift to neighbourhood health. But while the neighbourhood health rollout is underway, the role of medical specialists – doctors in fields such as cardiology and gastroenterology or geriatric and respiratory medicine – remains unclear.
The RCP says this must be defined if neighbourhood models, and neighbourhood planned specialist care, are to deliver more effective, timely care where patients benefit from the expertise of specialist doctors best equipped to contribute to their care.
New findings from a 2026 RCP member snapshot survey of physicians in England reveal that:
- 48% (of 414 respondents) said they were not very clear, or not clear at all, about how their medical specialist role would function within a neighbourhood health team
- 42% (of 417 respondents) expressed concerns about how delivering neighbourhood health will affect their day‑to‑day clinical work.
Physicians’ top concerns revolve around the practical enablers required for neighbourhood models to work safely and sustainably. The most frequently cited issues in the survey included:
- increased workload without protected time in job plans
- unclear clinical responsibility, accountability or escalation routes for complex patients
- reduced time for specialist inpatient or outpatient work
- increased reliance on virtual or remote consultations
- reduced access to timely diagnostics, specialist advice or hospital‑based infrastructure
- workload pressures affecting wellbeing or contributing to burnout.
The RCP’s new report sets out a vision for successfully embedding the role of medical specialists in neighbourhood planned specialist care. It says successful neighbourhood working will require a reshaping of how medical specialists work across the system, with changes needed to workforce planning, education and training, and digital infrastructure to enable physicians to work across traditional siloed boundaries.
Dr Hilary Williams, RCP clinical vice president, said: ‘We know from talking to our members up and down England, that physicians are excited about the opportunities of neighbourhood health, but nearly half are unclear about their future role. Healthcare is getting more complicated, and with rising multimorbidity and rapidly expanding treatment options for everything from COPD to cancer, the role of expert physicians working with communities has never been more important.
‘The challenge of modern healthcare is managing complexity and comorbidity – and this is what physicians’ medical training equips them to do. Our report today lays out the RCP’s vision for how neighbourhood health must use that expertise if patients are to see real benefits from these new models of care.
‘Neighbourhood working offers significant potential to deliver the reformed approach to planned specialist care that the RCP has long advocated for, but it will only be successful if it brings together the professionals that patients need for safe and effective care – medical specialists alongside primary and community expertise.
‘The RCP will work with our members and the NHS to bring our expertise and thinking to shape the role of medical specialists in this new model to ensure patients get the care they need.’
The report makes 10 recommendations aimed at the UK government, NHS England and local systems, including that:
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Integrated care boards work with physicians to define the role of medical specialists in their neighbourhood approach to planned care, including clinical responsibilities and when direct specialist input is required at different stages of planned care pathways
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The 10 Year Workforce Plan explicitly models physician roles and capacity within integrated neighbourhood teams including assumptions on time, skill mix and protected job-planned activity
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Government invests in well-functioning digital infrastructure and prioritises interoperability between systems, including the electronic patient record (EPR), so that clinicians have digital systems that enable joined-up care and shared decision-making across traditionally siloed teams
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Structured training opportunities for consultants, SAS doctors and resident doctors to develop neighbourhood-specific skills are expanded, including MDT working, remote oversight and managing clinical risk outside hospital settings
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Trusts are supported to maintain safe acute services as both funding and staff shift towards delivering planned care outside of hospital settings
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The Department of Health and Social Care and NHS England develop clear principles for a multimorbidity planned care pathway for adults who are not older or frail.
Dr Alice Cole, resident doctor, said: ‘Resident doctors’ training needs to reflect the realities of delivering neighbourhood-based care. The forthcoming postgraduate curriculum refresh must embed the right competencies and offer the right structured training opportunities to support residents to develop the skills needed for successful neighbourhood working. This must come alongside protected time for training for both residents and educators and reliable access to the digital tools needed for neighbourhood working.’
Dr Charlie Sharp, consultant in respiratory medicine said: ‘It can be extremely difficult for the physicians already contributing to community-based care to do this alongside the relentless pressures of acute services. That is why consultant job plans must be flexible and sustainable, supported by the workforce capacity to protect acute service delivery. Doctors at all career stages must have the time, training and job structures to work effectively across hospital and community settings.’