GPs in one area to deliver neighbourhood care through PCN contract variation
GP practices in one area will deliver a new neighbourhood care model for patients living with severe frailty using existing PCN arrangements.
NHS England has approved a request from Kent and Medway ICB to offer GPs a local variation to the Network Contract Direct Enhanced Service (DES) that will deliver ‘GP-led single neighbourhood care’ through the existing PCN arrangements – the first request of this kind to be approved, according to the ICB.
Earlier this year, ICBs were given new powers to vary the PCN DES at a local level with the approval of NHS England. Experts told Pulse that this could potentially ‘kill the possibility of single neighbourhood provider contracts’, which were announced as part of the 10-year plan.
NHS England had said that these amendments were separate from the single neighbourhood provider contracts, but Kent ICB’s announcement said that the variation will be used to provide ‘single neighbourhood care’.
It said: ‘The local variation is designed to support general practice to lead new single neighbourhood arrangements, focused on improving outcomes for people with the most complex health needs and is the first use of this power nationally.’
The ICB said that the variation was ‘developed jointly’ with Kent LMC, to ‘simplify arrangements, reduce fragmentation and strengthen continuity of care’.
It added that it ‘unlocked’ nearly £10m of new annual investment to ‘support patients with the most complex needs’ across Kent and Medway.
The initial focus of the new model will be around 92,000 patients including care home residents, people on palliative care registers, and housebound patients living with severe frailty.
For these patients, practices will provide:
- advance care planning discussions
- comprehensive geriatric assessments
- structured medication reviews.
The ICB said: ‘Although this group represents around 5% of the Kent and Medway population, they account for around 30% of hospital admissions and often experience longer hospital stays. Extended stays can lead to deconditioning and worsening frailty.
‘By providing proactive, wraparound care in patients’ own homes or usual place of residence, the model aims to improve outcomes and reduce unnecessary hospital admissions.
‘Practices taking up the contract will build on the clinically agreed model, developed with partners across the NHS system as well as evidence-based interventions already proven through local schemes.’
Kent LMC chair Dr Gaurav Gupta said the agreement ‘puts list-based general practice at the heart of neighbourhood health’ in the county.
He said: ‘We have agreed meaningful new investment into general practice to deliver evidence-based care to our most vulnerable patients.
‘This single neighbourhood model will allow practices and primary care networks to build upon the good work they are already doing, further improving outcomes for our communities.’
ICB chief executive Adam Doyle said: ‘We recognise that to make improvements in Kent and Medway we need to do real transformation and have been working with partners across and outside of the NHS to understand how we might make the shift.
‘We have had strong support across the system to change the way we do things within our four layers of care in which general practice is a significant part.
‘We have been working with stakeholders on the model we want to embed, to bring care closer to people’s homes.
‘As ICBs take on a stronger strategic commissioning role, we think we should be brave and start that process where we know it can make the most difference to people’s experience of healthcare and the outcomes they experience.’
Last month, the BMA advised PCNs to reject proposals to pilot single neighbourhoods if they lack ‘sufficient’ funding.
The union had anticipated that the new ICB powers would mean additional local services can be commissioned under the DES, removing the need for additional separate contracts to be commissioned by the ICB, but said that if additional funding isn’t attached to the pilots, PCNs should reject them.
NHS England previously said that the new neighbourhood contract models will be developed in this financial year.
NHSE said that 2026/27 will be ‘a developmental year’ for the new contractual models despite the contracts initially being expected at the end of last year.
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