NHSE director suggests GPs and hospitals could jointly lead neighbourhoods

GPs could lead new neighbourhood provider structures, either solely or with hospital ‘alliances’, NHS England’s medical director Dr Claire Fuller has said.

Dr Fuller said she was open to GPs taking on new neighbourhood contracts where they were ‘best placed locally to take them on’. 

Making the comments at an NHS Confederation event last week, she said contract holders would be ‘the best people locally to take them on’, and that ‘should be decided by local people’ .  

She said: ‘In some cases, that may be a hospital trust. In some places, it may be you’ve got a brilliant GP federation that should be doing it. In some places, it should be an alliance contract across those two.’ 

Dr Fuller has led the National Neighbourhood Health Implementation Programme, in which 43 areas were chosen to pilot the new neighbourhood health service.

As announced in the 10-year plan, two new contracts will enable GPs to work across larger geographies: single neighbourhood providers will deliver enhanced services across local areas typically covering 50,000 people – similar in scale to current PCNs; and multi neighbourhood contracts will serve around 250,000 people and deliver services that require coordination across multiple neighbourhoods, such as end-of-life care. 

Meanwhile, Integrated Health Organisations (IHOs) will hold the whole health budget ‘for a defined population’, with more contracts to be awarded when the model officially goes live in 2027. The Government recently revealed a list of eight ‘advanced foundation trusts‘ which will be among the first to take on the new IHO contracts.

Dr Fuller added: ‘You can’t have one organisation leading any of these bits on their own. You can’t have an IHO if you haven’t got relationships with your GPs, if you haven’t got relationships with your local authority.

‘It isn’t a binary thing, and increasingly I think these new contracts will be alliance contracts. I can’t see how anybody would end up being in an IHO if we didn’t have a mechanism making sure the general practice leadership across that patch was also there.’

It comes after GPs leaders recently voted in favour of ‘disengaging’ from neighbourhood provider structures unless they are ‘demonstrably led’ by general practice. 

One large ICB has already chosen a number of hospital trusts, instead of GP practices, to oversee the new ‘neighbourhood health service’ across its footprint, announcing that the trusts will also hold the funding.

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

Dr Fuller’s 2022 report on integrating primary care with other NHS services, known as the Fuller stocktake, recommended GP practices form ‘single urgent care teams’ across larger ‘neighbourhoods’ to improve patient access.