The NHS has been clear about what it wants neighbourhood health to deliver. To succeed, it must be built on the deliberate use of the full breadth of primary care and community partners.
This is not about diminishing the role of GPs – general practice is the foundation stone of local care – but about recognising a simple truth: the Neighbourhood Health Framework’s metrics cannot be achieved unless optometry, community pharmacy, dentistry, audiology and the voluntary, community, faith and social enterprise (VCFSE) sector are embedded from the outset.
There is a real danger that the national focus on minimum requirements becomes a sequencing trap. Neighbourhood health is not a modular add‑on. If systems start narrow, they will stay narrow. We have a window of opportunity to design something different – and permission to be innovative in meeting the needs of local communities. We should use it.
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What this means in practice
It means thinking holistically about population needs. It means working with providers of all sizes and scales to design and deliver the right pathways of care that genuinely shift care into the community.
If neighbourhood health is meant to keep people well and out of hospital, then the services that already demonstrably do that must be part of the design from day one. Access is a good example. Improving access to general practice is rightly a national priority, but access is not solved by GP capacity alone. It is solved by ensuring people reach the right part of primary care the first time. Wider primary care services are not peripheral to access; they are central to making it sustainable.
Every day, wider primary care manages millions of patients in the community, handles urgent presentations that would otherwise flow to GPs or the accident and emergency department, detects disease earlier, and prevents avoidable referrals and repeat attendances. This applies to planned care as much as urgent care. Ophthalmology remains the largest outpatient specialty in the NHS, with long waiting times in many areas. Scaled, integrated primary eye care can play a decisive role in reducing that backlog through effective triage, shared care for stable conditions and ongoing community‑based management – improving patient experience while freeing specialist capacity.
There is also a deeper opportunity
Optometrists, like other primary care professionals, see large volumes of people regularly, often earlier than other services. This places them well to support proactive population health management, identify risk earlier and reduce unwarranted variation between neighbourhoods. If key partners are missing from neighbourhood design, the prevention and inequalities agenda is weakened before delivery even begins.
Inclusive neighbourhood design is not idealism; it is the most realistic way to achieve short and medium‑term goals while laying the foundations for longer‑term change.
This also means recognising the role of not‑for‑profit primary care providers at scale, who exist because the system asked them to organise fragmented services, standardise quality, reduce administrative burden and deliver transformation. Capability, track record and public purpose should matter more than statutory status.
Neighbourhood health offers a genuine opportunity to move from ambition to delivery. But it will only work if we design for the system we need, not just the parts we are most comfortable with. The capability already exists. The question is whether we choose to use it.
Primary Eyecare Services is a not-for-profit primary eye care provider of NHS services, operating in 800 neighbourhoods, supporting more than 1 million patients a year, working with multiple integrated care boards, NHS trusts, local optical committees and local optical practices across England, delivering high-quality eye care services.
