GPs should refuse to pilot neighbourhoods if funding is insufficient, says BMA

PCNs should reject proposals to pilot single neighbourhoods if they lack ‘sufficient’ funding, the BMA has said in new guidance.

The union said that the changes to the PCN Network Contract Directed Enhanced Service (DES). announced at the beginning of the month are aimed at allowing local pilots of ‘single neighbourhood health providers’ announced in the 10-year plan, to be built around PCNs and their GP practices.

The changes introduce the ability for ICBs to vary the PCN DES at a local level with the approval of NHS England, introducing  ‘greater flexibility’ to tailor contract arrangements for PCNs to facilitate the creation of neighbourhood services.

The BMA said that this will mean additional local services can be commissioned under the DES, removing the need for additional separate contracts to be commissioned by the ICB, but that if additional funding isn’t attached to the pilots, PCNs should reject them.

The guidance said: ‘PCNs may be approached by their ICB about taking part in such a pilot. It’s important that all parts of the PCN are aware of what is being proposed and the potential impact in terms of funding and workload for all member practices.

‘Where ICBs are proposing changes that impose significant additional workload, and/or lack sufficient additional financial resource PCNs are strongly advised to reject participating in the proposals.’

The union said that ICBs should discuss all proposals with the relevant LMC as the representative of general practice within the locality and ensure that the PCN is ‘in full agreement before applying to NHS England to enact a variation’.

‘Where the PCN lacks full agreement to go ahead with the proposal, or where the LMC has not been adequately consulted, we would expect NHS England to reject the ICBs request,’ it added.

Cheshire LMC said that it is ‘likely’ that single neighbourhoods will be delivered through the DES, and suggested that GP practices ‘assess the worst-case scenario’ in which funding could ‘shift away’ from individual practices.

It recommended that practices ‘engage early with ICB’ and identify reliance on PCN and LES income.

The LMC’s chief executive William Greenwood said: ‘PCN and enhanced services income typically represents 30% of total revenue for a GP practice. A shift in funding control could, over time, affect both profitability and viability if not planned for.

‘This change will inevitably feel unsettling to many. It arrives during a period of wider system reorganisation, adding further uncertainty for general practice, however, it also creates opportunity.

‘Practices and PCNs that understand their numbers, have clear governance, and approach this strategically will be better placed to influence what happens locally rather than react to it.’

Meanwhile, PCNs in one area were given just 14 days to tell their ICB their proposed role within neighbourhood health centres. 

Last month NHS England 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.

The Government recently confirmed as part of a new framework that NHS trusts will have commissioning responsibilities for primary care, through new integrated neighbourhood organisation (IHOs) contracts.