Neighbourhood health model ‘may fail’ due to contracts delay, BMA warns

The Government’s plan for neighbourhood models ‘may fail’ due to a lack of guidance and a delay in publishing new contracts, GP leaders have warned.

Speaking at a webinar for BMA members earlier this week, the union’s GP committee executive faced questions about new neighbourhood contracts announced in the 10-year plan.

The plan had announced the introduction of two new contracts to offer an ‘alternative’ to the traditional GP partnership, which were meant to be published at the end of last year, but the GPC told the webinar these could now come out in April.   

GPC deputy chair Dr Samira Anane said: ‘We know there’s quite a few questions that have been submitted about neighbourhoods. There’s lots of talk on neighbourhoods, and we’ve been waiting for those contracts for that information.

‘The idea was that they would get published in November 2025 and in fact, that was the line in the medium term planning framework, that in November 2025 the expectation was that neighbourhood information would come out.

‘We’re still waiting. We anticipate that these will now come out in April. And this is not ideal, because, as we mentioned, they could potentially hold registered list sizes.

‘There could be threats to the partnership model, about funding flows, about destabilising well-established care for patients within their communities.’

NHS England has framed these contracts – which the 10-year plan said were due to be rolled out in early 2026 – as complementary to GMS but their scale and design have raised questions about the future of general practice, with ICBs also being allowed to offer them to a wide range of neighbourhood providers, including trusts. 

However, GPC chair Dr Katie Bramall said that the neighbourhood model ‘may well fail’, not because of issues with the concept itself, but because of a lack of guidance.

Dr Bramall said: ‘On the neighbourhood models, well, who knows what’s going to happen, but they may well fail, not because the concept is wrong, but because no guidance has been put out, because no one has been brave enough to stand up.

‘This is the problem, and at the moment, we’re just seeing silence in a vacuum. And if we allow silence, and if we allow a vacuum, if we allow the status quo, nothing will change.’

Pulse has asked the Department of Health and Social Care for an update on when the contracts will be published.

Earlier this month, the BMA told NHS England that the new structures, including integrated health organisation (IHO), should not be created ‘without the approval and consent of GPs’.

NHS England has said that GPs could lead the new structures, either solely or with hospital ‘alliances’, but the BMA voted in favour of ‘disengaging’ from neighbourhood provider structures unless they are ‘demonstrably led’ by general practice. 

Dr Anane reminded the webinar of this BMA policy, adding that GPs need to take a leading role in the new structures.

She said: ‘We do actually have policy from LMC conference on neighbourhoods, and they have to be GP-led. So that is the policy in terms of that and neighbourhood working – we’ve been doing it for, God knows, decades; that is what general practice is. We are the neighbourhood health centre. So let’s not let others define and put their shackles around us.

‘What is happening is whether there’s a contract or there’s guidance or policy or not, the trusts are going out, the trusts are writing. So in our area, they have written to say what their preference is on who’s going to host it. So people are moving and doing things, we cannot wait until that happens.’

The BMA has previously warned that trusts taking on neighbourhood contracts could ‘risk bankruptcy for GPs’.

And the GPC recently said that neighbourhood health transformation is ‘very far away’ and questioned whether the workforce and funding exist to deliver Government ambitions.

Dr Anane added: ‘We are not opposed to neighbourhood working with our stakeholders. We do that as GPs, day in, day out. We liaise with people, because we manage patients holistically. However, there really does need to be an honest conversation about what will be happening and the ramifications and who will be there to either plug those gaps or pick up the pieces.’