Health on the high street: Engineering a solution to community-based healthcare
February 11, 2026
Shifting health services into what used to be a shop or restaurant presents a major design challenge. Here’s how it can be done.
‘Health on the high street’ describes the idea of shifting certain health services out of hospitals and into the community. This has significant benefits, including those for the National Health Service (NHS), its workforce, patients, shopping areas, and the planet. Health on the high street also supports the government’s 10-year plan for the NHS, including the ‘three big shifts’.
- Hospital to community: Moving care away from hospitals into the community
- Illness to prevention: Through better access to health-promoting services
- Analogue to digital: Including better-integrated systems
However, recreating a highly regulated, clinical environment in what used to be a shop or a restaurant, for example, is far from straightforward. So, how can we realise the government’s goal to build 250 Neighbourhood Health Centres (NHCs)? And expand the existing fleet of Community Diagnostic Centres (CDCs)?
In the absence of new NHS design guidelines for these facilities, clinical planners and engineering teams will need to work together to find pragmatic but still effective solutions that focus on safety. Key areas include:
- Space utilisation and building layouts
- Safe patient flow
- Risk-managed ventilation strategies
- Complementing and making the most of the local environment
- Modular design
Shifting healthcare services from hospitals to communities will have significant benefits for patients, healthcare staff, high streets, and the planet.
The benefits of health on the high street
The benefits of moving health services into the community include:
- NHS and workforce: The move reduces pressure on hospitals and creates a more pleasant working environment for healthcare workers. They also enjoy easier access to work.
- Patients: It reduces waiting times and provides easier access to healthcare services for patients. They also receive treatment in a less intimidating environment.
- Shopping centres: Health on the high street is an opportunity to increase footfall to ailing shopping districts. It should also encourage more investment and regeneration in town centres.
- Planet: Local healthcare makes it easier for people to access health services using low-carbon transport. That reduces greenhouse gas emissions. People who normally drive to an appointment can walk, cycle, or take a bus. By using community hubs, Manchester University NHS Foundation Trust halved CO2 emissions from patient travel for specialist macular eye treatment.
I have worked on delivering some of the NHS’ 169 CDCs, which offer diagnostic services in places such as shopping malls and football stadiums. To expedite the growth of health on the high street, the government has now confirmed it will also invest in 250 NHCs. NHCs offer a broader range of services. The government describes them as ‘one stop shops’ bringing GPs, nurses, dentists, and pharmacists together under one roof. More than 100 are expected to be opened by 2030.
This is a positive step, as not all CDCs are in the local community—partly because of the challenges with converting existing community spaces into healthcare sites. Also, the more we integrate diagnostic services with other health and wellbeing services, the greater the chance that people will use them. With health on the high street, users would be able to get medical tests, mental health support, social care support, dentist appointments, and pharmacy services all in one place. And much closer to where they live and work.
Health on the high street also presents major design and engineering challenges. NHS design guidelines were written for hospital environments, not high streets.
Complex challenges, from accounting to engineering
This is all well and good in theory. However, the business model on the high street and the way the NHS operates couldn’t be further apart.
The NHS would be a good and trusted covenant for the landlord. However, ownership of high street units can be complex, and commercial rents tend to be higher than the NHS is used to. Furthermore, due to NHS financial rules, the trust needs to account for the full lease period in its budget, even though it isn’t paying for this up-front. This often exceeds its departmental capital expenditure limit.
Health on the high street also presents major design and engineering challenges. NHS design guidelines were written for hospital environments, not high streets. Also, many vacant units are in poor quality and would require a complex and expensive fit out. Other factors include the need for reliable backup energy generation and safe storage for medical gases.
Having said that, these challenges are not insurmountable. There is a growing body of experience around delivering health on the high street as more CDCs and other initiatives are delivered. I have seen some great examples of how we can overcome these challenges by combining healthcare excellence and engineering intelligence.
Designing community health centres
The health technical memoranda (HTMs) and health building notes are important in the design and construction of high-risk, patient-critical hospital settings. They apply the highest standards of quality and safety. However, they are ‘guidance’. And there is a challenge: Applying them to lower-risk, community health provision is restricting the speed at which decisions are made and costed for these types of facilities.
At Wood Green CDC, our design team was able to design a scanner room in the basement of an old retail unit.
The guidelines were first developed based on a limited number of room use types. With the introduction of health on the high street, the scope has changed dramatically. That means the standards need to be updated to cover more circumstances. In the meantime, we need a more pragmatic, but still safety-first approach, to design community-based health facilities.
Here are a few examples of how the UK can make the government’s dream for health on the high street a reality. We need to consider:
- Rooms and layout: At Wood Green CDC, we were able to design a scanner room in the basement of an old retail unit. Scanners are incredibly heavy and sensitive pieces of machinery. By reconfiguring the basement, took advantage of the solid floor. In these cases, you also need to consider access, fire strategy, and link with the fire strategy of the surrounding area.
- Patient flow: Reduce cross-contamination risks by creating clear patient flow and zoning for high-risk versus low-risk activities. While the HTMs do not relate to community healthcare, you can use the principles as a guide to deliver safe buildings.
- Risk-managed ventilation strategy: Healthcare buildings require a much higher degree of ventilation than you would typically find on the high street. Air-handling units are large, heavy machinery. And healthcare-ventilation systems need precise design and installation to work effectively. For health on the high street to work, you may need to consider a smaller unit, for example, and use some free-thinking to design a system that works. While this might not comply with NHS guidance, it might still support a risk-informed design.
- Local environment: There are many stakeholders on the high street. Commercial landlords and tenants. Residents. Other health and wellbeing professionals. Health on the high street can work well where these services complement the local environment and help drive footfall. Liverpool’s NHCs, for example, do well by combining healthcare services with cafes, commercial spaces, and pharmacies.
- Modular design: The UK has successfully deployed modular design in traditional healthcare settings, such as the MRI Diagnostic Centre at Furness General Hospital. However, it is still underused for health on the high street. Modular design could be a key aspect to delivering NHCs. For example, this would work well on derelict land or an old car park. For sustainability purposes, however, we must not forget the potential of existing buildings.
The government’s ambition for health on the high street is not an unrealistic dream. But it does require a considerable degree of free thinking in order to find safe and compliant solutions. Clinical planners and engineering teams must collaborate at the outset and consider the type of patients using the facility. Then you can profile the risk and make informed design decisions.
