‘Why Kent and Medway’s neighbourhood contract is worth GPs’ attention’
Drs Ash Peshen and Gaurav Gupta explain how Kent and Medway ICB’s newly approved neighbourhood care model based on using existing PCN arrangements – the first of its kind – will protect GP leadership
As GPs in Kent and Medway, we know neighbourhood working will only succeed if it is rooted in the realities of frontline general practice and shaped around the needs of patients. That is why Kent and Medway ICB and Kent Local Medical Committee have worked closely to develop an approach that is clinically grounded, practical and sustainable.
What has emerged is a genuinely collaborative model: one designed by general practice, informed by frontline experience and supported by commissioners who want to enable local leadership. The result is a neighbourhood contract that aims to make neighbourhood working more meaningful for practices, patients and system partners, while creating a stronger platform for integrated community care.
Starting where neighbourhood working actually matters
We started with a simple principle: neighbourhood working can add most value when it begins with patients who have the most complex needs. Rather than trying to do everything at once, the model initially focuses on a clearly defined cohort – including care home residents, people with severe frailty, housebound patients and those approaching the end of life.
These are patients for whom continuity, proactive care and coordinated support can make the greatest difference – and where general practice already plays a central role. Designing the model around this group gives neighbourhood working a clear clinical purpose and creates a strong foundation for learning as the approach develops further across long-term conditions, mental health, and children and young people.
Simplifying, not complicating
A consistent message from GPs involved in developing the contract was that neighbourhood leadership needs to be supported by a model that is clear, workable and manageable for practices.
The local approach responds to that by investing new money and bringing multiple schemes together into a single contract, reducing administrative complexity and replacing multiple claims with a single, more predictable payment. This gives practices and commissioners a simpler framework within which to support neighbourhood delivery.
That simplification matters because it creates more capacity for practices to focus on clinical leadership and to work effectively with multidisciplinary neighbourhood teams.
Backed by real investment
Another strength of the approach is the commitment of additional investment in general practice, allocated by population need and focused on patients requiring the most intensive support.
For those who opt in, this funding provides a stronger basis for planning and development in future years. That matters because neighbourhood working depends on the confidence to plan, recruit and invest over time. A more stable financial foundation gives practices a better opportunity to build a sustainable model of care for the future.
A clearer neighbourhood model: SNH and MNH
A further strength in Kent and Medway is the clarity of the neighbourhood model and the shared understanding between GPs and commissioners about how it is intended to work.
Single Neighbourhood (SNH) sits at PCN level and is GP-led, focusing on proactive and ongoing care for complex patients through continuity, care planning and coordination.
Alongside this, Multi-Neighbourhood (MNH) teams will provide additional support at scale, including urgent response, home visiting and enhanced multidisciplinary input. These teams are designed to wrap around practices, complement GP leadership and provide access to broader clinical support when needed.
This clearer distinction between proactive care and urgent response is intended to strengthen coordination, reduce fragmentation and support better flow across the system.
Protecting GP leadership
An important feature of the model is that GP leadership has been built in from the outset through co-development with the LMC and close working between GPs and commissioners. Our SNH model is firmly based on list-based general practice at its foundation.
The approach includes clear safeguards around professional autonomy and protection of core contracts. GP leadership is not an add-on; it is the foundation of the model, with commissioners supporting the conditions needed for neighbourhood working to succeed.
A realistic step forward
We are not suggesting this model will solve every pressure facing general practice, but it does offer a practical and constructive step forward for three reasons:
- It starts with a clearly defined cohort where neighbourhood care adds real value
- It simplifies existing arrangements rather than adding new layers
- It backs general practice with meaningful investment and influence
Local variation of the PCN DES provides an opportunity to align neighbourhood ambition with how general practice works in practice. When shaped collaboratively, it can support a more coherent model that reflects both clinical leadership and provider commissioner partnership.
This model will continue to evolve. Because it has been built through GP leadership and close collaboration with commissioners, we believe our model offers a credible and sustainable basis for neighbourhood working in Kent and Medway.
Dr Ash Peshen is deputy CMO at Kent and Medway ICB. Dr Gaurav Gupta is chair of Kent LMC
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