Hospital trusts to get delegated commissioning responsibilities for GP contracts
NHS trusts will have commissioning responsibilities for primary care under the Government’s new neighbourhood health model, the Department of Health and Social Care has confirmed.
A neighbourhood health framework published today said that trusts will be eligible to hold integrated health organisation (IHO) contracts as described in the 10-year health plan.
In all primary care contract types, including for general practice, contracts will continue to be commissioned in accordance with national contracts, with the ICB ‘delegating commissioning responsibilities to the IHO’, the document said.
It added: ‘Initially, these will be high-performing and highly capable advanced foundation trusts.
‘Designated trusts will be commissioned by ICBs using a newly developed IHO contract. We anticipate that community, mental health and acute trusts could all be eligible to be designated as IHO contract holders.’
The framework also said that the Government will consult on how multi-neighbourhood providers and single neighbourhood providers – which were also announced in the 10-year plan – will work together with GMS and the PCN DES, including how primary care networks ‘might evolve into single neighbourhood providers’.
According to the document, ICBs will contract a single IHO for an area, and the IHO will then contract a number of multi-neighbourhood providers, each of which will work with multiple single neighbourhood providers.
It clarified that single neighbourhood provider contracts will enable primary care to take on new neighbourhood services that are not contracted for through today’s general practice contracts, and that GMS and APMS contracts ‘will continue to be determined nationally and commissioned locally’.
Multi-neighbourhood providers will co-ordinate the ‘consistent’ delivery of services across multiple neighbourhoods, it added.
The document added: ‘Between multi-neighbourhood providers and single neighbourhood providers, it will be up to ICBs to decide in their commissioning how to organise these arrangements based on what’s right for their local population, although we would expect an appropriate level of coterminous arrangement.’
The framework also announced that NHS England will work with ICBs to ‘reform out-of-hours services’, so the public can better access care when GP practices are closed, and that this will be addressed in ‘upcoming strategy’.
It added: ‘We will begin reforming out-of-hours services, which are currently fragmented and inefficient, setting a common minimum expectation across all systems, including the relationship to 111. This will be addressed in the upcoming urgent and emergency care strategy.’
The Government also said that the NHS will introduce ‘a new model for planned care’ that meets the 10-year plan commitment of ‘ending outpatient care as we know it’, referring to the target for trusts to introduce a single point of access for GP referrals and the mandatory use of advice and guidance (A&G).
It added: ‘The NHS will put GPs in control when it’s unclear whether a patient needs specialist care, so people do not make unnecessary trips to hospital and instead focus on providing care closer to home.
‘GPs and secondary care consultants will work closer together, first by expanding advice through single points of access (starting with at least 10 specialties in all providers in the 2026 to 2027 financial year).’
The health secretary had previously suggested that there was ‘no reason’ GPs could not lead IHOs.
The BMA has argued that GPs must take leadership roles withing neighbourhoods now, and it also warned that encouraging trusts to take over GP practice premises suggests the Government wants secondary care to lead neighbourhoods, rather than GPs.
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Please note, only GPs are permitted to add comments to articles
GPs are doomed if this comes to pass
Trusts will suck all the resources into hospital based care like happens in most vertically integrated systems.
If you read the works of Barbara Starsfield you will realise what a disaster this will be .
rearranging the deck chairs on the titanic
Implications for GP provision, services, GMS, training and education are catastrophic. OOH via 111 with no continuity; and very reason why GPs will neither be able to lead IHOs, nor have any control. No sign whatsoever of genuine leadership or improvement for patient care. Instead, a series of US-style contracting with inevitable cost-cutting, wastage and clinical detriment. Continuing arse-about-face.
This all looks like a message from Streeting’s sponsors. Bye bye GMS. Bye bye NHS unless enough coordinated pressure makes another U Turn happen.
Why GP Surgeries — Not Hospital Trusts — Must Lead Primary Care Commissioning
1. What the Government Is Proposing
The Government’s new Neighbourhood Health Model confirms that NHS hospital trusts will be handed delegated commissioning responsibility for primary care, through new Integrated Health Organisation (IHO) contracts.
[pulsetoday.co.uk]
This means organisations already struggling with waiting lists, deficits, and governance failures will be given power over GP services.
This is not reform — this is centralisation dressed up as integration.
2. The Facts: General Practice Outperforms Every NHS Trust in the Country
GP surgeries deliver more care, more efficiently, with cleaner finances
GP practices provide 90% of NHS patient contacts for around 8% of the NHS budget (widely published data).
GP surgeries operate with balanced accounts — no structural deficits, no historic bailouts, no PFI debt.
Trusts, meanwhile, are routinely in financial deficit and rely on central cash injections, something never required by GP partnerships.
Even the Government’s own framework admits the local system is failing
The neighbourhood health framework highlights long‑standing fragmentation, repeated failures of coordination, and the need to completely rebuild local service design.
[gov.uk]
Who didn’t cause those failures?
General Practice.
Who did?
A system dominated by trust and acute‑centric decision‑making.
3. Why Trust‑Led Primary Care Commissioning Is Dangerous for Patients
a) Built‑in conflict of interest
Trusts would be both providers and commissioners of primary care — marking their own homework.
Neighbourhood commissioning research warns that ICBs must maintain independent, strategic commissioning to avoid provider dominance.
[bjgp.org]
Putting trusts in control breaches this principle on day one.
b) A return to hospital‑first thinking
The Government claims this shift supports a “left shift” into the community.
But giving hospitals control over GP services does the opposite: [gov.uk]
Resources are drawn back into acute settings.
Community care loses autonomy.
Patient access worsens.
c) Loss of continuity and personalised care
Continuity of care is the strongest predictor of lower mortality, fewer admissions, and better patient satisfaction.
Trust‑led commissioning replaces person‑centred care with system‑centric targets.
It is bad medicine, bad policy, and bad economics.
4. The Legal Reality: The Law Favors GP‑Led Commissioning
Health and Social Care Act 2012
Commissioning must be:
Clinically led
Independent
Free from conflicts of interest
Handing primary care commissioning to hospital trusts — who also provide competing services — is the clearest possible conflict.
Provider Selection Regime (Health Care Services (Provider Selection Regime) Regulations 2023)
Neighbourhood health contracts (SNP/MNP) must be offered to the Most Suitable Provider, under lawful processes described in the regime.
[localgover…wyer.co.uk]
GP organisations — PCNs, federations, partnerships — are already identified as the natural providers for neighbourhood models in Government guidance.
[localgover…wyer.co.uk]
There is no legal basis for trusts to be given commissioning primacy.
NHS Act 2006 (as amended)
Commissioners must:
Improve quality
Reduce inequalities
Ensure value
GP‑led commissioning demonstrably fulfils all three.
Trust‑led commissioning historically fulfils none.
5. The Government’s Own Plan Shows Primary Care Should Lead — Not Take Orders from Trusts
Neighbourhood health guidance explicitly states that:
PCNs are naturally aligned to “single neighbourhood provider” footprints
GP federations are already delivering multi‑neighbourhood services successfully
[localgover…wyer.co.uk]
Yet the new policy proposes to sideline the very organisations the neighbourhood model was designed around.
This is incoherent policy-making.
Don’t worry guys, it says only highly performing foundation trusts will be able to hold them, so none, hahahahahahaha
Fully agree with you David. Looks like they want GP’s to do consultants outpatients work .
Secondary care has very different priorities than primary care.
Each need to fight for their resourcing.
Inependemce and ability to argue for more GP resource goes into the trash.
Hospitals will just suck in mire money
Our only hope is that most trusts are too busy struggling to balance their books and to meet existing targets that they will not want this extra hassle.