Trust-run neighbourhood services and collective action: July’s big talking points
Pulse takes on July’s talking points – how involved will trusts be in running neighbourhood services, and is collective action on the horizon again?
Will trusts take on neighbourhood health services?
The Government’s hefty 10-year health plan left many GPs scratching their heads earlier this month. Tagged as part of Labour’s ‘plan for change’, the document promised sweeping reforms to improve access and rebuild patient trust in primary care. You know the gist by now: analogue to digital, hospital to community, and sickness to prevention blah blah blah.
But there was one thing that caught many off guard: the introduction of two neighbourhood-level contracts, as an ‘alternative’ to the GP partnership model. The first will support ‘single neighbourhood providers’ covering areas similar to current PCNs. The second will create larger ‘multi-neighbourhood providers’ to coordinate services across several neighbourhoods.
Many are already uneasy about what these new contracts mean for the traditional GP partnership model, and how they will coexist with the existing GMS contract. But there are also fears that, rather than supporting GPs, these neighbourhood contracts could open the door for NHS trusts to take on a larger role in running primary care services.
Speaking at a webinar held after the 10-year plan’s release, NHS England’s primary care director Dr Amanda Doyle took questions from GPs about the new contracts. She did little to allay concerns about acute and community trusts taking up these new contracts, saying that this could happen where primary care is ‘not stepping up’.
Let’s ignore the fact that this sounds vaguely threatening (like an ultimatum) and threateningly vague (ie, does ‘not stepping up’ mean not doing unfunded work?) The very notion of trusts taking on these contracts upsets the whole essence of neighbourhood care. General practice, by its very nature, is already embedded in the community. The RCGP released a statement voicing the same concerns – saying that while it was not against collaboration, any model of a neighbourhood service would need to have GPs ‘as core partners, not just participants’.
These concerns are not theoretical, nor are they in some distant future. From September, 42 areas will be part of the first phase of the ‘neighbourhood health programme rollout’. And, South East London ICB has already chosen a number of hospital trusts to oversee its new neighbourhood health service. The commissioner has approved partnerships (‘neighbourhood service integrators’) between primary and secondary care, with the plan suggesting that secondary care trusts will ‘host the arrangements’. Pulse has asked SEL ICB to clarify whether this means they will hold the contracts for neighborhood services.
It was also revealed this week that GP leaders in Staffordshire have advised practices to hold off from participating in the neighbourhood pilot, because of a ‘lack of clarity’. North and South Staffordshire LMCs told GPs to wait until there is certainty that GMS contracts will be protected, leaving many wary of committing to models where their role and authority remain undefined.
These doubts have been echoed nationally. In a document on the rollout of the National Neighbourhood Health Implementation Programme (NNHIP), the BMA warned GPs that to avoid the sidelining of traditional ‘continuity of care focussed general practice and primary care’, active clinical GP leadership was essential. Any absence could create a ‘vacuum’ which trusts and other large providers may be all too ready to fill.
This is not just a turf war. Letting trusts take on general practice contracts would mark a transition away from locally led care and towards more centralised, top-down models of delivery. It’s also the very antithesis of the oft-quoted ‘left shift’. If trusts begin to dominate neighbourhood contracts, general practice risks being relegated from a clinical profession that leads, to a service that simply delivers. That’s bad not just for GPs, but for patients too. Continuity of care, access, and trust in the system are all at stake – eroding the very principles of primary care that the 10-year plan claims to protect.
Are we headed for collective action again?
Turn back the calendar one year exactly. GPs in England had just begun to take collective action – the first of its kind in 60 years. Incensed by the imposed 2024/25 contract, GPs around the country pushed back on unfunded work. Those with a keen mind will also remember that the newly-appointed health secretary also announced that GPs would be able to be hired through the ARRS the very same day. In a hope to quell collective action, Wes Streeting added £82m to the ARRS pot to hire 1,000 more GPs as an ‘emergency measure.’
Collective action did make its mark. It certainly made national headlines (the Daily Mail said that it could cost the NHS half a BILLION pounds). And, there were reports of successes too. One ICB told GPs that it would carry out a review of all local enhanced services after doctors served collective notice on ‘unfunded work’. Another ICB invested an additional £2m into services after collective action highlighted gaps.
In March, the BMA announced it was no longer ‘in dispute’ with the Government. The pause in collective action came after accepting a contract deal for 2025/26, which included a commitment from DHSC for a new wholesale renegotiation of the GMS contract within this parliamentary term. At the time there was a sense of tentative progress: after years of short-termism, there was a promise of structural reform.
Yet just four months later, that stability is showing signs of fraying.
Pulse exclusively revealed earlier this month that GPs in England were open to re-entering into dispute with the Government over its 10-year health plan. A motion at the BMA GP Committee’s meeting lamented the plan’s approach to general practice and lack of progress in negotiating a new GMS contract. Pulse understands that the motion was taken as reference, but there was still a possibility of further dispute.
Following this, GPC chair Dr Katie Bramall wrote to primary care minister Stephen Kinnock, setting out a series of red lines for future negotiations. Chief among them was that ARRS money be given to GP practices; without doing so, ‘meaningful negotiation on any new contract may not be possible’. The letter warned that failure to deliver on this – and the other priorities listed – could see GPs engage in collective action again.
It seems that it has come back full circle to ARRS a year on, and highlights a deeper issue. While the Government sees ARRS as a key workforce investment, for GPs it is an inflexible framework that undermines autonomy. The debate is not simply about resources, but about the ability of practices to know what they need and shape services that reflect that – a fundamental concern as negotiations over the future of the GMS contract begin.
Meanwhile, all is not well in the devolved nations. Northern Ireland GPs began collective action this week for the first time, following an imposed 2025/26 GMS contract. The BMA said that GPs will reduce unfunded work until they receive an ‘improved financial offer’ from the Department of Health. In Wales, the Senedd has launched an inquiry into general practice, looking at funding and workforce issues. While the details and contexts differ, the direction of travel is the same: rising pressure, simmering discontent, and growing willingness among GPs to challenge the status quo.
So, are GPs in England headed for another round of collective action? The warning signs are there. We know that it might look different to last time. GP leaders voted against ‘escalated measures’ such as co-ordinated practice closures and walkouts, but did agree to push the BMA to organise peaceful protests.
Whether GPs will fully re-engage in collective action depends on how the Government responds in the coming months; not just with funding promises, but with genuine negotiation on autonomy, workload, and long-term shifts. The profession is watching closely. If talks stall or the 10-year plan fails to deliver meaningful change, the pause may well turn out to have been just that – a pause.
