The NHS 10 Year Plan outlines an ambitious agenda to move care closer to home, reduce hospital admissions, and empower communities to take a more central role in health delivery.
The government has announced plans for new Neighbourhood Health Centres which will support the shift from hospitals to community-based care, drawing on the experience of places as varied as Australia, Brazil, Canada and Costa Rica, as well as the UK, all of which offer valuable lessons on how to successfully deliver integrated, people-centred primary health care.
Supported by funding from the ESRC, these examples were shared with the Secretary of State for Health and Social Care and the NHS 10-Year Plan team at an international roundtable at King’s College London in March 2025, in collaboration with the Institute of Development Studies (IDS) and the Department of Health and Social Care (DHSC).
Their experiences demonstrate that with the right policies, workforce strategies and governance, health systems can deliver better outcomes, reduce costs and enhance equity, say experts from Kings College London, the Institute of Development Studies and Imperial College.
Watch: IDS response to the NHS 10 Year Plan
Wes Streeting MP, Secretary of State for Health and Social Care, said:
“We know that the change in our plan is possible, because we see it already happening. We toured the length and breadth of the country and scouted the world for the best examples of reform […]. If community health teams can go door-to-door to prevent ill-health in Brazil, we can do the same in Bradford. We know we can build the neighbourhood health service, because teams in Cornwall, Camden, Northumbria and right here in Stratford are already showing us how to do it. So we’ll take the best of the NHS to the rest of the NHS, and we’ll apply the best example of innovation from around the world to benefit millions of people here at home.” (Taken from speech, 3 July 2025)
Chaired by Professor Andrea Cornwall of King’s College London, the roundtable offered an opportunity to explore learning from international experience of building neighbourhood primary care and prevention teams, working with former ministers and state secretaries of health and academic experts with experience in health reform in Brazil, Canada, Chile, Costa Rica, India, Japan, New Zealand, South Africa and Zimbabwe, and across Asia and Africa. The group discussed what works in community-based health and care, and how to bring about the change needed for delivering the shift from hospital to community.
Professor Andrea Cornwall, King’s College London, said:
“When I wrote to Wes Streeting offering to convene a conversation on learning from international experience to feed into the new NHS 10 Year Plan, I didn’t expect him to answer. But I was wrong. He and his team at the DHSC took me up on the offer and were genuinely interested in what Britain could learn from other countries. The new NHS 10 Year Plan reflects what they heard: a commitment to the kind of community-based primary health care that’s driven real change in health outcomes around the world.”
Britain is already learning from Brazil’s innovations in primary health care. Imperial College’s Dr Matt Harris brought the Brazilian Community Health Worker model to the UK twelve years ago. Now it’s being used in Pimlico, Cornwall and other locations around Britain, and will soon be scaled up to more.
“Through building trusted relationships, and regular home visits, CHWWs ensure all residents are supported, whatever their needs are”, said Dr Harris. The CHWWs become the visible face of the NHS in the community – as Jennifer Kherlakian Constantine from King’s College London, whose research is on public policy innovation and exchange between Britain and Brazil, puts it, “the equivalent to the ‘bobby on the beat.’” Brazil is ahead of us in Britain, with thirty years’ experience and some 300,000 community health workers serving 145m citizens across the nation. But already there have been impressive gains where the Community Health and Wellbeing Workers (CHWW) model has been tried in the UK, with reductions in the use of accident and emergency services and sharp rises in uptake of preventive services such as immunisation and cancer checks.
Dr Cornelia Junghans Minton, GP and Clinical lead for the Community Health and Wellbeing Workers, Healthcare Central London and Imperial College London, said:
“I am pleased that the Community Health and Wellbeing Workers feature front and centre in the NHS 10 Year Plan. A signal that this government is serious about radical change and willing to learn from excellence in countries we don’t normally look to for inspiration.”
Research led by IDS with partners in Brighton & Hove and funded by the ESRC through the Trans-Atlantic Platform has documented England’s experience of decentralising budgets and decision-making during the pandemic to support neighbourhood and community-led health strategies, providing robust evidence on how decentralisation can enable more effective and agile service delivery at the local level.
As the project Principal Investigator Dr Alex Shankland, Research Fellow, IDS underlined:
“We know community-led health services can work internationally, and we know they can work here in the UK. We hope that the Secretary of State will follow through on the important intention set out in the 10 Year Plan by supporting genuine devolution of decision making and resources to frontline health systems managers, local councils, and, crucially, local community groups.”
Read more about the Building Back Better from Below project
The experience of Canada, Chile, Costa Rica, and Japan shows that linking neighbourhood health centres into a learning health system offers opportunities for continuous improvement, sharing evidence horizontally to support local-level learning and aggregating insights to inform national policymaking.
These countries’ experiences show that investing in partnerships with universities and research organisations is also essential to the success of delivering primary health care reforms at pace and at scale, both for workforce training and wider system-wide research cooperation between the Department of Health and Social Care, NHS, UKRI, and the higher education sector, as shown by recent research from King’s Health Partners.
Dr María del Rocío Sáenz Madrigal, MD, former Executive President of the Costa Rican Social Security Fund (CCSS), former Minister of Health of Costa Rica and Coordinator of the Social Council, said:
“Information systems are key for advancing prosperity and development, not just in Latin America but globally, and for monitoring health equity, the resilience of health systems, and the implementation of explicit policies and practices aimed at eliminating health inequities.”
Research from the countries represented at the roundtable shows that that universal access to high-quality, equitable community care, supported by data-driven population health planning, is achievable with consistent investment and political will, even in resource-constrained settings.
Professor Luis Augusto Facchini, MD, Federal University of Pelotas; Lead of the Brazilian Primary Care Research Network; former Municipal Secretary of Health for Pelotas, Rio Grande do Sul, Brazil, said:
“It has been a pleasure to be part of this important effort. The NHS Fit for the Future 10-year plan is an ambitious and necessary response to reclaim the principles of a health system that is so relevant to the world. Community health centres will be central to this vision, by anchoring care in local contexts and integrating services around the patient. The plan can bridge the gap between acute care and community care. If implemented well, the strategy can reduce pressure on hospitals and make care more accessible, especially for groups that have historically been left behind. But it will be very important to strengthen investment in the health workforce, building teams able to increase the problem-solving capacity of primary health care and counting on the structural and integrated support of other sectors of the health system.”
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