The Health Minister has today published a long-awaited framework to transform how health and social care is delivered across Northern Ireland, promising to shift care “closer to people’s front doors” through a new neighbourhood-based system. Mike Nesbitt’s Neighbourhood Model of Health and Wellbeing, published on 31 March 2026, establishes 17 Integrated Neighbourhood Teams intended to bring together GPs, community pharmacies, trusts and voluntary groups to deliver more proactive care in local communities rather than hospitals.
The model represents the operational blueprint for the Minister’s “shift left” policy, which aims to move resources from acute hospitals into community settings. It follows extensive consultation including a Call for Evidence that attracted 183 submissions, and enters its implementation phase next month amid significant financial pressures and a history of stalled reform programmes.
Four Pillars of the New Model
The framework sets out four key pillars that will guide the restructuring of services:
- Integrated Neighbourhood Teams (INTs): Seventeen teams will act as provider alliances across GP Federation areas, serving average populations of 115,000 people. These will replace previous advisory models like Integrated Care Partnerships with formal operational structures responsible for day-to-day delivery.
- Moving care closer to home: Redesigning clinical pathways to strengthen anticipatory and proactive care, with an initial focus on older people to enable smoother hospital discharge and better support to “thrive at home.”
- Neighbourhood innovation programme: Providing data and digital infrastructure to encourage system-wide change and measure outcomes.
- Neighbourhood relationships and connections: Central to the model, emphasising co-production with communities and equal partnership with the Voluntary, Community and Social Enterprise (VCSE) sector.
The Department emphasises that this approach links to a forthcoming “This is Our Health” initiative and a new “sensible care” approach that offers more shared decision-making between professionals and patients.
Implementation Begins April 2026
The model will be introduced in phases. Following a design phase that ran from September 2025 to January 2026, the current build phase establishes neighbourhood development programmes and delivery systems. Full implementation commences in April 2026, with all 17 Integrated Neighbourhood Teams beginning formation in the first year.
The initial focus on older people reflects what the Department identifies as the area of greatest need, prioritising earlier, proactive support to reduce avoidable hospital admissions. The framework notes that Northern Ireland is projected to have the largest increase in older people across the UK over the next 25 years.
Funding the Shift
The Minister acknowledges that delivering the model requires a “mixed funding approach” during a period of severe financial constraint. The Department faces a projected £600 million gap between available funding and the cost of maintaining existing services.
The funding strategy includes:
- Redirecting Health and Social Care Trust resources away from hospitals into community settings
- Dedicated core funding for Neighbourhood Teams
- “Invest-to-shift” opportunities where savings from reduced hospital activity are reinvested
- External funding partnerships
A significant external commitment comes from Macmillan Cancer Support, which has pledged up to £10 million over the next three to five years through its Neighbourhood Transformation Fund.
Voices from the Sector
Health Minister Mike Nesbitt framed the publication as a necessary response to unsustainable pressures:
“It is well-known that demand for HSC services is rising, workforce pressures are intensifying, and our current ways of working don’t have the capacity to cope. What has become clear is that doing more of what we’ve always done won’t get us where we need to go. We need to do things differently.
“Last year, I promised a new model of Neighbourhood Care which would bring care much closer to people’s front doors. Early in the development process we recognised that there are many providers with considerable expertise and experience already working in communities. Therefore, it made sense to bring them all together, with a focus on prevention, early intervention and providing the right support when needed.”
“This is only the beginning of a journey to make real, sustained and meaningful change. The model has involved extensive work from officials in my Department, and input from a wide range of stakeholders. Our Call for Evidence gathered an impressive 183 real-world examples which have shaped and inspired our model.”
Ruth Sutherland, CBE, Chair of the Patient and Client Council, welcomed the emphasis on partnership:
“Working in partnership, in your neighbourhood, to shape services that work for your community is the best way to achieve results. The public, local communities, local councils, voluntary and community sector organisations and others have a wealth of knowledge, experience and expertise that can help shape, deliver and advance services at a local level for best outcomes.
“The shift in relationship that is needed, between the HSC system and the public, essentially involves moving from a doing to, or for approach, to doing with people in communities. The Minister’s approach offers a real opportunity to embed People as Partners across our Health and Social Care system going forward.”
Gemma Peters, Chief Executive of Macmillan Cancer Support, confirmed the charity’s financial commitment:
“I am proud that Macmillan’s Neighbourhood Transformation Fund has committed to investing up to £10 million to provide that vital support. By working in partnership, we are moving away from inconsistent service gaps towards a new standard of excellence. Our investment is not just about increasing capacity, it is about ensuring that seamless, equitable care becomes a reality for every person in need of expert support when it matters most.”
Unanswered Questions and Historical Context
While the framework sets out ambitious structural changes, several critical details remain unclear. The document does not specify the exact quantum of public funding allocated to neighbourhood teams beyond the general “mixed funding” description, nor does it address how the model will interact with the ongoing dispute between the Department and GP partners over the 2025/26 GMS contract.
The British Medical Association has previously warned that the neighbourhood model “simply will not happen without first resolving the dispute with GP partners,” citing chronic underfunding of primary care. The framework acknowledges that “progress has been constrained by financial pressures,” yet does not explain how these constraints will be overcome to fund new neighbourhood infrastructure without destabilising existing services.
The publication also arrives against a backdrop of previous reform attempts that failed to deliver promised shifts to community care. The 2011 “Transforming Your Care” review and the 2016 Bengoa Panel report both identified the need to move care from hospitals to communities, yet data shows hospital-based care has continued to dominate. The Department’s own research notes that Northern Ireland has the longest waiting times of any UK region for accident and emergency departments, with one in six of the population on an outpatient or inpatient waiting list as of mid-2025.
The Compendium of Good Practice published alongside the framework includes 183 examples of existing neighbourhood initiatives, ranging from dementia-friendly models to pharmacy partnerships. However, scaling these isolated successes to a system-wide transformation of 17 neighbourhoods represents an unprecedented operational challenge.
Five Questions for Stakeholders
- How will the Department ensure the 17 Integrated Neighbourhood Teams do not simply add another bureaucratic layer to an already complex system, particularly given the history of “right drift” where funding flows back to hospitals despite community-care policies?
- With the ongoing GP contract dispute and reports of chronic underfunding across primary care, what specific guarantees are there that GP federations will have the capacity and resources to participate as equal partners in these new alliances?
- The model relies on “invest-to-shift” savings from reduced hospital activity to fund community care. What contingency plans exist if these savings fail to materialise in the short term, given the rising demand from an ageing population?
- Given that disabled people and carers already face the most widespread barriers in accessing current services, according to Equality Commission research, how will the new model specifically address these access inequalities rather than assume uniform neighbourhood benefit?
- The framework commits to “sensible care” and shared decision-making. How will the Department measure whether this represents genuine patient empowerment or simply a transfer of responsibility to individuals at a time of reduced service availability?
What Happens Next
Implementation begins in April 2026, with the Department establishing systems for measuring outcomes and evaluating progress. The Minister has indicated that the model will be supported by a new approach to “sensible care” that emphasises maintaining independence and quality of life through shared decision-making.
Macmillan’s £10 million investment will begin flowing into the system over the coming months, potentially providing early test cases for whether the social investment model can deliver measurable reductions in hospital activity. The