GPs must take neighbourhood leadership role now – not wait for contracts, BMA advises

Local GP leaders should develop ‘written neighbourhood propositions’ for their area amid a delay from the Government in publishing new contracts, the BMA has said.

In a briefing document, the union’s GP committee warned that if GPs ‘remain passive’ neighbourhood contracts will be ‘hosted elsewhere’ and general practice will ‘carry clinical risk without financial leverage’.

Their document comes as amid a delay to the publication of guidance on neighbourhood health contracts, which GP leaders have complained has left the NHS in a ‘vacuum’.

But despite the lack of guidance, some ICBs have already chosen trusts – rather than GP practices – to lead their neighbourhood models.

NHS England and Government leaders told neighbourhood stakeholders including GPs ‘not to wait’ for the neighbourhood health guidance to be published before starting to work in the new manner suggested 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 thinks these could now come out in April.   

The GPC had previously warned the Government’s plan for neighbourhood models ‘may fail’ due to a lack of guidance and a delay in publishing contracts.

Their briefing document to GPs said that GP federations and PCNs should develop their own written plans and that they should engage ICB chairs and CEOs ‘proactively’ rather than ‘reactively’ and ‘build alliances with supportive acute partners’.

The BMA document said: ‘Waiting for single neighbourhood provider (SNP) contracts to appear is not strategy and is unwise. Design the model before it is handed to us as a contract.

‘There remains an implicit belief in parts of the system that acute trusts cannot fail and must therefore control reform. But protecting buildings is not the same as protecting patients

‘General practice has already proven its productivity and fiscal discipline. It is neither radical nor unreasonable to argue that the most efficient sector of the NHS should shape the future model.

‘This is likely the last realistic opportunity to intervene before behaviours, contracts and expectations become locked in. Left shift will not happen through goodwill, it will only happen through design. We need to lead or be led.’

In a podcast published by the BMA at the end of last month, GP Committee England chair Dr Katie Bramall said that the lack of published guidance on the new neighbourhood contracts left GPs and others in a ‘vacuum’.

And she argued that clear rules must be made available including for how funding would flow through the new contracts.

She said: ‘Every pound that flows through a neighbourhood model must be fully traceable, and reinvestment has got to be documented and visible. No public funding released through neighbourhood delivery should be diverted into opaque internal cross subsidies to mop up acute deficits or shareholder profits.

‘Mandatory reinvestment should be a condition of participation, because if you don’t have that, trust is going to collapse. And clinical engagement is going to be lost. And I think it’s true to say that the neighbourhood model isn’t going to fail because the concept is wrong. I think the concept is sound. The risk here is that everything’s going to fail or grind to a halt because we need discipline and we need rules, and we all need to be doing the same thing.’

It comes after the 2026/27 GP contract changes stipulated that PCNs will be required to work with ICBs to ‘achieve greater alignment’ between PCN and neighbourhood areas. This will be done by amending the Network Contract DES to mandate collaboration on PCN footprints. 

Pulse’s publisher Cogora is launching a new conference focused on neighbourhood health, taking place at the National Conference Centre, Birmingham on 21-22 June. GPs, practice managers, community pharmacists, nurses, PCN and ICB leaders are invited to the CPD-accredited event. Find out more about the agenda and register for free here.