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How neighbourhood contracts will be affecting general practice?

There are two types of neighbourhood providers; the new multi-neighbourhood provider (MNPs) and the single neighbourhood provider (SNPs). This has sparked debate on the future of primary care and the lack of concrete detail would mean that despite there being a 10 Year Health Plan to counteract this, general practice still faces uncertainity.

Robert McCartney, a partner from a law firm named Hempsons stated that the counsultation was far from clear about what that changes would mean for patient care.

“We are waiting for the answer to the key question of what are the neighbourhood services? What services are going to be at the SNP level? What are going to be at the MNP level?

DES – Directed Enhanced Services

PCN – A (primary care network) is a group of GP practices and local health services working together to deliver coordinated, community-based care. In practical terms, it is essentially a local partnership that shares staff, services and data to improve access and outcomes. It was introduced in 2019 as part of the NHS Long Term Plan, PCNs in healthcare aim to improve patient access, manage population health, and ease pressures on GP surgeries. The NHS PCN model allows practices to pool in resources and share services, from clinical pharmacists to social prescribing, helping to deliver more personalised, proactive care to social communities.

SNPs – From April 2026, the NHS is expected to introduce the Single Neighbourhood Provider (SNPs) contract, a new contract designed to streamline commissioning and integrate services at the neighbourhood level. It will consolidate services and health inequality initiatives under a single accountable provider for populations of around 30,000 – 50,000 patients that are already existing in the PCN files.

Why PCN incorporation is still key…

To hold an SNP contract, they anticipate a provider must be able to;

• Deliver regulated services across multiple sites
• Demonstrate robust governance, operational capability and integrated working, and
• Employ staff, hold contracts, and manage risk independently

New SNP contracts would ‘enable the delivery of neighbourhood-level enhanced primary medical services through integrated neighbourhood teams (INTs) within a single neighbourhood’, the consultation said.

NHS England said it saw an ‘opportunity for general practice to grow as neighbourhoods deliver more services’. The contracts would ‘build on and simplify’ existing approaches to primary care commissioning and ‘represent an evolution’ from the network contract DES. ICBs would be able to choose whether to keep the PCN DES or move to the new contracts, the document said. ‘We would protect the income by putting minimum funding requirements in place for any variations to the PCN DES and in the SNP contract,’ consultation documents said. ‘We also think that for general practice to opt out of the PCN DES and switch to an SNP contract, they will want to see not only simpler service specifications but additional services and funding.’ ICBs will have the flexibility to define most of the contract content and fund it locally. However, NHS England added that there was ‘no new national funding for these contracts’. NHS England also said that the PCN DES and the SNP contract should not ‘co-exist in the same geography’.

SNP contracts will be used to commission primary care services that are not provided through the GP contract. ICBs would determine the length of these contracts, which some practices may find more attractive than the PCN DES, which can change each year. The consultation sets out three options for how SNPs or PCNs could be commissioned in future:

1. ICBs commission a local service specification by applying to vary the current PCN DES to better reflect local priorities.

2. ICBs use the SNP contract to commission ‘enhanced neighbourhood-level primary medical services’ directly from SNPs. Practices in the area would stop delivering the PCN DES and switch to the SNP contract. SNP contracts could run over multiple years, unlike the network contract DES. Initially, some PCN DES requirements could remain mandatory and ICBs would be required to maintain a minimum investment in the SNP equivalent to the PCN DES, including ARRS funding.

3. ICBs commission MNPs, who then subcontract to SNPs. In this case, the MNP would be mandated to subcontract the neighbourhood primary medical care services to SNPs. As with option two, there would be a minimum SNP funding requirement equivalent to the PCN DES. MNPs would also be able to commission PCNs to provide services.

In the second option, NHS England said that ICBs would have the ‘flexibility to locally increase the scope and value of services commissioned through the SNP contract, including through the inclusion of additional locally commissioned services and associated funding, without requiring national approval’. This suggests local enhanced service funding that practices currently receive will fall under the scope of SNP contracts, as many GPs have feared. The holder of an SNP contract will need to be a legal entity, but NHS England said this could be ‘a lead practice on behalf of a consortium of practices’. ‘There would be no requirement for practices to form separate legal entities if they do not wish to do this,’ it added. The consultation suggested that practices would be able to opt out of parts of the SNP contract, in which case the MNP would be required to deliver those services to patients. Practices would also have the ability to exit and join SNPs at defined times.

MNP contracts
The consultation said that multi-neighbourhood providers (MNPs) should be commissioned using the NHS Standard Contract ‘with an additional “Neighbourhood” schedule’. This new schedule would ‘allow for the delivery of enhanced primary medical services (contracted in line with new national ‘Neighbourhood Directions’), enabling commissioners to contract more easily with an MNP for services that include both primary medical and non-primary care elements. We envisage that this would include the ability to sub-sub-contract services and enable access to NHS pensions,’ it said.

MNPs would need to have ‘clear relationships with single neighbourhood providers (SNPs) and GP practices’, to ensure that services are delivered to the registered population. ICBs would ‘stipulate the SNPs that the MNP must sub-contract with’ and these arrangements would enable SNPs to opt in or out of services over the term of the contract. To hold an MNP contract, an organisation would have to be a legal entity, but the contract could be held by a single organisation or by a ‘lead provider on behalf of a consortium of providers’. ICBs would also determine the length of these contracts, the consultation added. NHS England has suggested that there could be more than one MNP contract within an area. ‘For example, one MNP contract may be focused on 24/7 urgent general practice and another focused on coordinating integrated neighbourhood teams to deliver a service,’ it said. ‘In this scenario, the nature of the services commissioned and the number of MNP contracts would be locally determined.’

As part of the consultation, respondents are being asked whether they agree that practices should be able to ‘opt in’ to SNP arrangements and how MNPs should demonstrate their support for general practice during the procurement process.

Sources;
https://coreprescribingsolutions.co.uk/primary-care-network-management-support/

https://www.gponline.com/neighbourhood-contracts-will-affect-general-practice/article/1965348?bulletin=bulletins%2F60secondgp&utmmedium=EMAIL&utmcampaign=eNews%20Bulletin&utmsource=20260723&utmcontent=60-Second%20GP%20(187)

https://www.gponline.com/nhs-england-consultation-sets-new-neighbourhood-contracts-work/article/1964821

https://www.lexology.com/library/detail.aspx?g=7b23f916-6cf1-4b21-87bf-5d98bbce7821