GP primary care networks could be split to align with neighbourhood health areas
PCNs will be required to work with ICBs to ‘achieve greater alignment’ between PCN and neighbourhood areas, according to the 2026/27 GP contract.
In the letter outlining contract changes on Tuesday, NHS England said it would amend the Network Contract DES to mandate collaboration on PCN footprints.
Although it added it should not lead to ‘widespread reconfiguration’.
The news comes amid a delay to the publication of guidance on neighbourhood health contracts, which GP leaders have complained has left the NHS in a ‘vacuum’.
The GP contract letter said: ‘We will amend the Network Contract DES to require PCNs to work collaboratively with their ICB to achieve greater alignment between the PCN registered list and the neighbourhood, where an ICB, working with the Local Authority, defines a neighbourhood around a natural community that does not match current PCN geography.
The letter added that the change ‘is not intended to signal widespread reconfiguration of PCNs’ and ‘is expected to apply only in limited circumstances’ as a ‘pragmatic safety net where existing arrangements clearly do not reflect local communities’.
It comes as NHS England and Government leaders this week told neighbourhood stakeholders including GPs ‘not to wait’ for anticipated neighbourhood health guidance to be published before starting to work in the new manner suggested in the 10-year plan.
DHSC permanent secretary Samantha Jones told attendees at an NHS Confederation event on Monday that guidance would be released ‘shortly’, amid ongoing concern from GP leaders over a perceived lack of clarity on neighbourhoods.
NHS England’s medical director Dr Claire Fuller said at the same event: ‘The reason why it’s taking so long to get the guidance out is to make sure it doesn’t get in the way of people. Those people that are flying, you’ve got to let them really fly. It’s not about stopping people doing things if it is working right.
‘Those people that are struggling – put some guidelines in to identify your high-priority cohorts, sort out your geography, make sure you have got enough capacity.’
She went on to say to those involved in neighbourhoods: ‘I will say all of you just, you know what you’re doing, you know your population, you know what you need to do to make it better.
‘Please do not wait for guidance, please do not wait for permission – you know what you need to do.’
But the BMA’s GP leaders have expressed concern over the lack of centralised guidance.
In a podcast released by the BMA last week, GPC England chair Dr Katie Bramall told deputy chair Dr David Wrigley that ‘so much’ of the detail on neighbourhoods is still unknown, with this lack of direction enabling trusts to ‘actively block’ their development.
Dr Bramall said: ‘(The guidance) was originally promised in Autumn then it was going to be Christmas, then the new year. Now it’s Spring. It’s meant to be setting significant central direction about neighbourhood health – this is the Government’s big flagship framework.
‘But so much of it is unknown and it’s very difficult for leaders to build expectations into realistic plans if information is in a complete vacuum.’
According to Dr Bramall, this has led to ‘ICBs being very unwilling to devolve budgets to anyone’.
‘I think we can see acute and community health trusts actively blocking reform because they have that intrinsic fear of loss of income and contracts.’
‘Neighbourhood teams are really unclear about who actually holds authority. There’s lots of parallel lobbying and positioning going on rather than actual delivery planning. And so in that context, you’re not going to have innovation. You’re going to have people locking in what they feel they currently own.’
The podcast also saw the GPCE chair and deputy express concerns about the neighbourhood contracting’s potential impact on the GP partnership model.
Last month, the GPC warned the Government’s plan for neighbourhood models ‘may fail’ due to a lack of guidance and a delay in publishing contracts.
Read all of our coverage of the 2026/27 contract here.
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READERS' COMMENTS [5]
Please note, only GPs are permitted to add comments to articles
I am not a policy theorist or management consultant, but as a clinician who has watched the NHS evolve, and stumble, over decades. Through every reform, one truth has remained constant: healthcare succeeds when it treats people as human beings, not as entries on a spreadsheet or components in a grand organisational blueprint.
The proposed Neighbourhood Health Centres, embedded within the 2025 Ten-Year Health Plan and its broader “neighbourhood health service” vision, promise transformation: care closer to home, multidisciplinary teams under one roof, prevention over crisis management, integrated diagnostics, mental health and social care in a seamless one-stop model.
On paper, it is compelling.
Yet I leave LMC meetings unsettled — not enlightened. Despite pages of diagrams and aspirational language, I struggle to understand how this model will feel from the patient’s chair — the one I see every day, still delivering eleven clinical sessions a week.
And I cannot escape the conviction that, in their current form and trajectory, these centres are destined to fail.
Not because the intentions are flawed. But because the design misunderstands the foundations of effective healthcare in the real world of flesh-and-blood people.
POSTULATE NUMBER 1: HEALING HAPPENS THROUGH RELATIONSHIPS, NOT EFFICIENT HANDOVERS
The most powerful therapeutic intervention in general practice has never been a protocol or pathway. It is continuity.
Continuity is the quiet accumulation of trust built by seeing the same GP — or small, stable team — over time. It is the clinician who remembers the context behind “I’m tired all the time.” Who notices subtle change. Who understands family dynamics without needing a summary read aloud. Who makes decisions shaped by narrative, not merely numbers.
The evidence is unequivocal: continuity reduces unnecessary investigations, improves chronic disease outcomes, lowers hospital admissions, and even reduces mortality.
Yet the neighbourhood model dilutes this at its core.
Patients become attached not to a person, but to a large team serving 30,000–50,000 people: care coordinators, pharmacists, specialist nurses, mental health practitioners, social prescribers — each expert within a defined domain. Patients circulate between them, retelling their story, fragment by fragment. The human thread thins.
Vulnerable patients suffer most. When no one truly knows them, they disengage.
Policy documents reassure us that continuity will be “prioritised for those who need it most” through risk stratification and care coordination. But no coordinator — however skilled — can meaningfully hold thousands of complex human narratives amid turnover, sickness, and shifting roles.
What emerges is not integration, but polite fragmentation.
POSTULATE NUMBER 2: HYPER-SPECIALISATION ERODES HOLISM
General practice was built on medical generalism — the disciplined art of seeing the whole person.
Neighbourhood teams risk dissolving this into silos: diabetes lead, frailty lead, prescribing lead, social prescribing link worker, mental health practitioner. Each excels within a box. But no one owns the whole picture.
The GP — once the integrator of biological, psychological, and social strands — risks becoming a supervisor of pathways and a signpost to services.
Something vital is lost.
Professional meaning erodes when clinicians cease to practise broadly and relationally. As a senior GP, I have seen the early signs: joy draining from the role, identity narrowing, burnout accelerating. Recruitment and retention worsen. New doctors are shaped into ever narrower functions rather than contextual thinkers.
Healthcare becomes technically proficient — yet existentially thin.
Humans do not present in compartments. They need clinicians who can connect the dots.
POSTULATE NUMBER 3: INSTABILITY UNDERMINES TRUST BEFORE IT BEGINS
Even if the model were philosophically sound, its execution sits on unstable ground.
Changing contracts, boundaries, funding streams, and organisational responsibilities every 6–12 months is akin to rewriting the rules of football mid-season. By the time practices, PCNs, and teams adapt — realigning geography, rebuilding relationships, retraining staff — the policy shifts again.
Neighbourhood provider contracts promised for 2026 now drift toward 2027/28. Consultations are pending. Guidance evolves. Certainty evaporates.
Energy is diverted into compliance, restructuring, and survival. Box-ticking replaces improvement. Output falls. Morale declines.
Patients are promised “joined-up care,” yet experience delay, confusion, and transition fatigue.
We have seen versions of this before — most notably in the Darzi polyclinic experiment of the 2000s. The architecture changes. The underlying flaw remains.
The NHS repeatedly pursues system-level redesigns while neglecting human fundamentals: stability sufficient to build trust, relational continuity over transactional efficiency, holism over hyper-specialisation.
Time and familiarity as therapeutic tools
Until policymakers recognise that healthcare is not an industrial process but a human covenant, these Neighbourhood Health Centres risk joining a long list of well-intentioned reforms that promised revolution but delivered disruption and disillusionment.
The NHS does not need another structural reinvention.
It needs to protect and properly resource what already works.
It needs to restore stability.
It needs funding continuity as a measurable, protected outcome.
It needs to allow GPs to function as the holistic anchors they trained to be.
It needs reducing fragmentation rather than rebranding it as integration.
Reform does not require novelty. It requires humility.
Healthcare is not healed by architecture. It is healed by relationship.
Trust is minimal when other providers are empowered to reject GP requests to see patients (referrals) on an endemic scale, now backed up by national policy.
Excellent commentary, EC. Despite this, though, successive health ministers have chosen to play politics with the NHS rather than employ reason and evidence, as you have. In line with their neoliberal economic theory, they’re driven to smaller public spending and “shocking” constant change in order to break the back of the NHS – so that it becomes easier for them to sell the argument for privatisation.
EC you are enlightened. I see both medical students & GP trainees in my current role & it scares me shit less. Common sense & an outbreak of profound reality & adult discussion. around patient management is profoundly lacking IMHO
If politicians accept the original model of GP care worked and just needs funding properly they have nothing to take credit for and their role is defunct. They exist to micro manage. Same with trust managers. They are also in charge and are therefore unlikely to realise how little they have to offer or to recognise their limitations and lack of knowledge and leave the job to those who have the training and experience. Hence managers ever increase in number and usefulness and politicians remain micro managing twats. Shame really