With the new government coming to power, the collective action, and the lack of any real pointers as to what is to come in the existing, rolled-over contract there is a lot of uncertainty as to the future for general practice.  A key question is whether PCNs will continue.

However, we do know that the new government is very keen on what they term a “neighbourhood health service”.  For PCNs this brings hope, because they are the closest existing NHS structure to what might be meant by a neighbourhood, but at the same time uncertainty because the government rarely mention PCNs and do not seem to them as synonymous with neighbourhoods.

So what is a neighbourhood, and how are they different from PCNs?

There are some insights into this question in the NHS Confederation’s recent publication “Working Better Together in Neighbourhoods”.   This does acknowledge that neighbourhoods are difficult to define, and starts with the premise that the closest recognised structure to neighbourhoods is not PCNs but rather the Integrated Neighbourhood Teams outlined within the Fuller Report.  These teams bring together professionals from health and care providers as well as voluntary, community and social enterprise organisations – i.e. a much wider range of professionals than currently exist within PCNs.

The report, “supports the Darzi review findings that INTs, in a statutory context, are essential to health and care services being more proactive, preventative and person-centred. This requires organisations within neighbourhoods to be able to integrate their structures and relationships.”

The push, then, is very likely to be for PCNs to develop into Integrated Neighbourhood Teams (INTs), but not as loose collaborative constructs like PCNs but rather as a formal part of the NHS.  Exactly how this may happen is not something that is explicitly addressed by the report.

The NHS Confederation document goes even further and argues that neighbourhoods need to be more than the bringing together of local health and care providers into some form of statutory entity.  It emphasises the need for an active role for communities within neighbourhoods.  It argues that successful neighbourhood working exists “somewhere in the middle of a spectrum that ranges from wholly community-led to wholly statutory led”.

The report explains more about what it means by this, “INTs and related approaches to working with communities will need to align to, but are not the same thing as, community-led development… A PCN-led model may have a principal goal of expanding the ability of the practices to meet patient needs, whereas a community group may focus on building social capital and community connectedness.”

So while PCNs are owned and controlled by GP practices, neighbourhoods will not be.  According to the report they will encompass a range of local health and care providers and will need to be built in partnership with local communities.  The report ends up by recommending that the GP contract be reformed so that general practice can play a leading role in neighbourhood health models.  It also recommends that primary care resources should be aligned around neighbourhood priorities.

While the document has no formal status it is indicative of the direction of current thinking.  How this will play out remains to be seen but the implications are significant.  For general practice the independent contractor model may be more at risk than ever, and PCNs are likely to see a rapid evolution into one of the building blocks of this new neighbourhood health service.