What Does the Return of Public-Private Partnerships Mean for Neighbourhood Health Centres?

The government’s NHS 10-Year Health Plan, announced last July, set out an ambitious vision for the future of community care, including plans to open 250 new neighbourhood health centres (NHCs) across England. While the focus on bringing services closer to patients and easing pressure on hospital outpatient departments has been widely welcomed, questions have remained around delivery — particularly funding.

Recent announcements in the Autumn Budget, followed by comments from a health minister, have begun to provide greater clarity. Around 80% of newly built NHCs are now expected to be privately funded through public-private partnerships (PPPs), with approximately four in ten centres delivered within existing NHS buildings.

With PPPs firmly back on the agenda, Integrated Care Boards (ICBs) face a critical moment. What lessons can be learned from previous PPP healthcare projects, and how can systems prepare to make this new wave of neighbourhood health centres a success?

Lessons from Previous Public-Private Partnerships in the NHS

Looking back at earlier NHS PPP models, one thing is clear: they work best when there is clarity of scope, predictable demand and assets with long operational lives. These conditions provide private investors with confidence around returns and delivery timelines.

This is why new-build facilities with standardised designs and well-defined service models tend to attract more interest than complex schemes with uncertain requirements. In many respects, neighbourhood health centres could be an appealing proposition, bringing together established primary and community services under one roof without the need for highly specialised clinical infrastructure.

However, past PPP programmes also highlight the risks of inflexibility.

Healthcare delivery evolves quickly, driven by research, workforce pressures and changing patient needs. Buildings that cannot adapt easily risk becoming outdated long before the end of their design life. For NHCs — which will host multiple services — flexibility must be built in from the start. Value for money depends on sustained utilisation and close collaboration between partners to ensure facilities evolve alongside care models.

Equally important is the strength of the partnership itself. Successful PPP healthcare projects rely on transparent relationships, aligned expectations and a shared understanding of objectives. Where public and private motivations differ, those differences must be openly acknowledged rather than allowed to undermine trust.

Refurbishment Versus New Build: A Critical Strategic Choice

While much of the focus has been on new facilities, the NHS already holds a substantial estate of underused or vacant buildings. Refurbishing existing primary and community care sites is often the fastest and most cost-effective way to increase capacity — particularly in urban areas where land availability is limited.

Refurbishment also supports more sustainable development by prioritising existing assets before creating new ones.

Yet refurbishment carries higher risk for private investors. Projects are typically lower in value, with unknown asset conditions that can quickly inflate costs. Shorter building lifespans also weaken the investment case. Unsurprisingly, the government has confirmed that refurbishment programmes will be funded directly by the public sector rather than through PPPs.

This creates a dual delivery model: privately funded new builds alongside publicly funded refurbishments.

How Integrated Care Boards Can Prepare for PPP Healthcare Projects

For ICBs, this mixed approach introduces complexity — but also opportunity.

The first step is gaining a detailed understanding of existing NHS estates, including current utilisation, latent capacity and the condition of underused assets. This must be aligned with future service models under the NHS 10-Year Health Plan to ensure estate strategies support long-term care delivery rather than short-term fixes.

Crucially, neighbourhood health centres should not be treated as a single delivery model. ICBs will need to plan explicitly for the split between PPP-funded developments and publicly funded refurbishments.

To attract private investment, systems must also create credible propositions. This means developing clear pipelines, consistent specifications and robust demand forecasts — giving investors confidence while retaining enough flexibility to meet local needs.

A Testing Ground for the Future of NHS Infrastructure Investment

Neighbourhood health centres will act as a proving ground for the next generation of public-private partnerships in healthcare. With the benefit of hindsight from previous PPP programmes, there is an opportunity to design partnerships that are more flexible, more collaborative and better aligned with patient outcomes.

With clearer signals from government and careful preparation at system level, ICBs can help ensure that PPP healthcare projects deliver modern, adaptable facilities — supporting improved access to care while making effective use of both public and private capital.

If done well, the return of PPPs could play a vital role in reshaping community healthcare infrastructure for the decade ahead.