What are the new neighbourhood contracts expected to look like?

Pulse sums up NHS England’s plans for the new neighbourhood structures and GP contracts

NHS England has now launched an eight-week consultation on the proposed new neighbourhood contract models – including further detail on what multi-neighbourhood and single neighbourhood providers are expected to look like; as well as what they may mean for the future of PCNs.

What are the plans for multi-neighbourhood providers (MNPs)?

MNPs will plan and organise NHS services that include both primary and non-primary care elements across several neighbourhoods (usually covering around 250,000 people or more)
This may include delivering NHS services directly at a larger scale than a single neighbourhood, or ‘filling in’ services within a single neighbourhood where it is locally agreed to be more appropriate for an MNP to deliver
MNPs will be commissioned using the NHS standard contract with an additional ‘neighbourhood’ schedule
Trusts ‘may be more familiar’ with the NHS standard contract but NHS England sees ‘many organisations having the potential’ to take on MNP contracts
NHS England is ‘considering a safeguard’ where commissioners would need to ensure there is ‘GP support for any MNP’
There could potentially be more than one MNP contract within a single geography, 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.
There is no new national funding for these contracts.

How will MNPs be organised?

According to the documents, there are two ways to organise MNPs:

Option 1: Coordination model

The MNP helps organisations work together
Existing contracts with providers stay in place

Option 2: Lead provider model

The MNP takes full responsibility for outcomes across multiple neighbourhoods
Existing services are brought together under one contract

Source: NHS England

What are the plans for single neighbourhood providers (SNPs)?

SNPs would enable the delivery of neighbourhood-level services through integrated neighbourhood teams within a single neighbourhood
They are intended for the delivery of ‘enhanced primary medical neighbourhood services’ that are not contracted for through GMS
The SNP contract is ‘an evolution’ of the PCN DES which local systems ‘can take forward at their own pace’
Practices would have the option to remain in the PCN DES or ‘take up one of the other options if their commissioner proposes it’
There will be ‘minimum funding requirements’ for SNPs, to ensure practices do not see a drop in funding with the move to SNP
The SNP contract would be created based on new ‘neighbourhood directions’ – these directions would also underpin the new ‘neighbourhood schedule’ within the MNP contract
ICBs would determine the length of SNP contracts
They can be awarded to ‘all eligible providers (including having access to the registered patient list) who express an interest’.
Where practices choose not to ‘opt into’ a part of the SNP contract, the MNP would be required to deliver those services to patients. Practices would have the ability to exit and join SNPs at defined times, and the MNP would enable this.
There is no new national funding for these contracts.

How will SNPs be commissioned?

The options could not be taken forward in parallel, commissioners and PCNs would need to choose one.

Option 1: Use a variation of the current PCN DES

Keep the current nationally defined PCN DES entitlements and requirements
Allow integrated care boards (ICBs) to add local services and funding with national agreement

Option 2: Commission SNPs directly

ICBs contract directly with SNPs
ICBs determine local services and funding
SNPs deliver local enhanced primary medical care in single neighbourhoods
SNPs may sub-contract to other organisations in support of delivering those services (for example, supporting case finding for high priority cohorts of patients)
There may still be some nationally defined entitlements and requirements. ICBs maintain a minimum investment in the SNP equivalent to the existing PCN DES

Option 3: Use an MNP model

ICBs commission an MNP to coordinate the delivery of neighbourhood services across multiple neighbourhoods and commission SNPs to deliver services in single neighbourhoods
ICBs contract with an MNP
ICBs stipulate the SNPs that the MNP must sub-contract with
The MNP then works with SNPs to deliver enhanced primary medical care or delivers the services itself if needed (i.e. there is no SNP locally, the SNP declines or is unable)
SNPs may sub-contract to other organisations in support of delivering those services ( for example, supporting case finding for high priority cohorts of patients)
There may still be some nationally defined entitlements and requirements. ICBs maintain a minimum investment in the SNP equivalent to the existing PCN DES

Source: NHS England

What will happen to PCNs?

NHS England says that the SNP contract as ‘an evolution and a strengthening’ of PCNs and that they ‘will be protecting’ the PCN funding (including the Additional Roles Reimbursement Scheme) as systems move towards SNP Contracts.

ICBs will have the choice over keeping the current PCN DES or moving to one of the proposed options in the consultation document. Practices would have the option to remain in the PCN DES or take up one of the other options if their commissioner proposes it. LMCs are expected to play a key part in coordinating this transition.

What about the GMS contract?

The consultation does not propose changes to GMS. According to the documents, it is ‘Government policy’ to ‘keep and reform the GMS contract’, and NHS England also stressed that GMS will ‘continue to commission core general practice services’.