A new Royal College of Physicians (RCP) report sets out its vision for the role of planned specialist care in neighbourhood health, calling for physician expertise to be embedded in integrated neighbourhood teams, with the capacity and capabilities to make the model work.
Neighbourhood health is a central pillar of the government’s plans to transform the NHS as set out in the 10 Year Health Plan for England, with a commitment to shift most outpatient care out of hospitals by 2035 and introduce neighbourhood health centres in every community.
The RCP supports the ambition to deliver more proactive and joined-up care closer to people’s homes. However, there is currently insufficient clarity about how planned specialist care – and physicians in particular – will operate within neighbourhood models.
The RCP view on neighbourhood health: planned specialist focuses on the role of medical specialists within neighbourhood planned care and the practical enablers required to deliver integrated, high-quality planned care closer to home.
Physicians are highly trained specialists with the expertise needed to manage medical complexity, uncertainty and risk within planned care pathways. They make diagnostic and treatment decisions for patients with complex needs, weighing risks, and determining when to intervene, escalate or stop treatment. This expertise is increasingly vital as more patients are living longer with multiple health conditions, whose needs span primary, community and specialist services and cannot be safely or effectively met by a single provider alone.
Findings from a 2026 RCP snapshot survey of clinically active members in England highlights significant uncertainty about how neighbourhood health will work in practice. Almost half (48% of 414 respondents) said they were not very clear, or not clear at all, about how their specialist role would fit within a neighbourhood health team. Their biggest concerns were:
- increased workload without protected time in job plans
- unclear clinical responsibility, accountability and escalation routes
- reduced capacity for inpatient and hospital based specialist work
- greater reliance on remote or virtual consultations without adequate support
- limited access to diagnostics, digital systems or shared patient records
Workforce capacity emerged as the biggest barrier to successful delivery of neighbourhood health, cited by nearly 300 physicians (74% of 404 respondents). Many already balance acute service delivery alongside planned care, leaving little capacity to take on additional neighbourhood health duties that may require travel or training. The report highlights the importance of the forthcoming 10-Year Workforce Plan in ensuring sufficient specialist capacity to support neighbourhood health alongside rising acute demand.
The report makes 10 recommendations aimed at the UK government, NHS England and local systems, including:
- Clearly define the role of physicians within neighbourhood planned care, including their role in providing clinical care, advisory input, team upskilling and system leadership.
- Explicitly model physician roles and capacity within integrated neighbourhood teams in the forthcoming 10 Year Workforce plan, including assumptions on time, skill mix and protected job-planned activity.
- Expand structured training opportunities for consultants, SAS doctors and resident doctors to develop neighbourhood-specific skills, including MDT working, remote oversight and managing clinical risk outside hospital settings.
- Support flexible job planning to allow specialists to work safely and sustainably across neighbourhood, hospital and remote settings.
- Ensure trusts are supported to maintain safe acute services as both funding and staff time are rebalanced towards neighbourhood-based planned care.
- Put in place the right enablers for neighbourhood working, including interoperable digital systems, strategic commissioning based on population need and clearly defined clinical accountability and escalation pathways.
You can download the full report and summary for policymakers below.
Development of the ‘RCP view on neighbourhood health: planned specialist care’ was led by the RCP’s clinical vice president, Dr Hilary Williams. The report draws on findings from a 2026 RCP all-member snapshot survey, insights from a roundtable with medical professionals working in areas where neighbourhood health is being rolled out, and input from focus groups with members of the RCP’s career-grade committees and Medical Specialties Board. The report was approved by RCP Council prior to publication.