All the signs point to “neighbourhoods” as the next priority area of focus for the NHS.  The new government has spoken repeatedly about creating a “neighbourhood health service”, and at the recent NHS providers conference Secretary of State Wes Streeting stated that the role of ICBs should no longer be performance management but instead he said,

“I want ICBs to focus on their job as strategic commissioners and be responsible for one big thing: the development of a new neighbourhood health service.”

So while we await whatever is to be included in the promised 10 year plan, one thing we can be relatively certain of is that neighbourhoods are going to feature front and centre.  At the same time PCNs are getting less and less of a mention, so it also pretty reasonable to assume that while practices operating together at a PCN level will continue, primacy will shift from PCNs to neighbourhoods.

The question, then, is what does this mean for PCNs and practices, and what (if anything) should they be doing now to prepare for this shift?

Here are 5 actions I would recommend:

1. Strengthen PCN working. General practice will still hold a pivotal role in neighbourhood working.  PCNs as group of GP practices within a neighbourhood will be very important and will need to be strong together to be able to shape how the neighbourhood functions.  While there is a temptation right now for practices to retreat into core service delivery and away from PCN working, doing so would fracture the unity of local general practice and reduce its influence within the new neighbourhoods.

2. Match PCNs to neighbourhood boundaries. In recent years the pressure has been on community teams and others to match to PCN boundaries, but the nature of neighbourhoods mapping to both local communities and existing community and social care teams means that the pressure will most likely now come for PCNs to change rather than vice versa.  We have seen this already in the NW London Integrated Neighbourhood Team  It would be sensible where there is not an existing alignment for PCNs to start to think about how they could make this happen in the least disruptive way, before the system imposes its own inevitably heavy-handed approach.

3. Focus on building strong relationships across the local area. Neighbourhood working ultimately relies on local relationships.  Just as effective PCN working requires strong relationships and trust across the practices, the same is true for all the different organisations working across a neighbourhood.  Relationships take time to build, so early investment in them now will pay big dividends in the future.

4. CDs take on a leadership role for cross-organisation working initiatives. Lots of pilots and MDTs are already springing up in local areas, as systems start to gear themselves up for neighbourhoods.  PCNs playing an active role not only within these initiatives but in leading them is extremely sensible preparation for the future, as it will position primary care as the natural leader for these emerging neighbourhoods.

5. Support local at-scale general practice to prepare to become an “integrator”. GP federations have been in and out of favour over the last 10 years, but one important emerging theme in all the publications about neighbourhoods (going right back to the Fuller report) is that there will need to be some form of at-scale support for them.  This could be from general practice (i.e. a federation) or from an NHS or local authority organisation.  If general practice is keen to both be able to influence the way neighbourhoods develop and is keen to protect its on ongoing independent contractor status then there would be a lot of value in the local federation taking on this integrator function.  To do this, however, local PCNs and practices will need to actively support it now so that when the time comes it is in a position to be able to take on this role.