From hospital to community? The good, the bad, and the ugly of the 10-year plan to move care to the community

Labour's 10-year health plan for England, published on 3 July, set out three strategic shifts -from hospital to community, sickness to prevention, and analogue to digital. 1 This editorial focuses on the first -shifting care from hospital to community -and considers its implications for general practice, drawing on existing evidence to explore the good, the bad, and the potentially ugly.The proposed shift from hospital to community hinges on the development of Neighbourhood Health Services, delivered by multidisciplinary community-based teams -including GPs, nurses, pharmacists, paramedics, and a mix of other staff.The plan also proposes Neighbourhood Health Centres (NHCs), to be open at least 12 hours a day, 6 days a week, and offering colocated NHS, local authority, and voluntary sector services.To incentivise the delivery of these services, the plan proposes two new neighbourhood contracts -a 'single neighbourhood' provider contract aiming to build on primary care networks (PCNs), covering a population of around 50 000; and a 'multineighbourhood' contract to cover a population of around 250 000, aiming to support back-office functions, digital transformation, estates, data analytics, and quality improvement.While large-scale GP organisations, such as federations, may be able to take on multi-neighbourhood contracts, they will also be open to NHS Trusts.Operating at a larger scale, integrated health organisations (IHOs) are also proposed.To be led by the 'very best' NHS Foundation Trusts, IHOs would hold the whole health budget for a defined population.The plan states these will become the 'norm' over time.