Neighbourhoods are on the way.  Ever since integrated neighbourhood teams formed the centrepiece of the Fuller Report this has been clear, but it is now even more so with the Labour government’s repeated statements about a “Neighbourhood Health Service”.  But what do neighbourhoods mean for PCNs, and what will the relationship between the two look like?

Just to be clear right at the outset, PCNs and neighbourhoods are not the same thing.  Maybe the original intention behind PCNs was for them to evolve into some form of multi-agency community organisation, but the reality of where we are now is that the two are very different.  PCNs are groups of GP practices in a neighbourhood area working together, whereas neighbourhoods comprise all the different local NHS, social care and voluntary organisations.

This means PCNs will be just one element of many within neighbourhoods.  For those concerned (or even hopeful!) that neighbourhoods will mean the end of PCNs I don’t think there is any chance of this.  Neighbourhoods need all the GP practices working together and will not want to return to the situation where each GP practice is operating individually.  PCNs will continue, but the question is what the relationship between the PCN and the neighbourhood will be.

We don’t yet know the detail of the plan for neighbourhoods, and will most likely have to wait until the new NHS 10 year plan is published in the Spring to find this out.  But the all the signs are that they will be actual entities (as opposed to the loose collaboration that is perhaps the best description of practices working together in a PCN).  This means that they will be able to hold budgets and have some degree of organisational infrastructure, beyond that which we currently see with PCNs.

The plan for neighbourhoods is that they will be enablers of effective joint working between the different providers in the local area.  So where a PCN might currently run up against a brick wall if it is trying to form an effective partnership with, say, the local mental health provider, the neighbourhood will be able to unblock any barriers and ensure that in this situation the PCN and the mental health provider can find a way of working together.

The question is what levers the neighbourhoods will have to unblock these barriers.  It could be some form of accountability framework, whereby leaders from all the provider organisations form the neighbourhood leadership team and are accountable there for ensuring their organisation participates effectively in partnership working.

This seems unlikely to be sufficient on its own, as partnership arrangements based on goodwill only ever get you so far.  More likely, then, is that there will be some financial levers.  If the neighbourhood controls access to any neighbourhood funding that is announced as part of the new plan, then it can use this to ensure providers participate in neighbourhood working.

These levers may be even more pronounced for PCNs.  It is not beyond the realms of possibility that PCN funding will shift from being a DES in the national contract to being held by the new local neighbourhood entities.  If this does end up being the case then this will mean the neighbourhood effectively becomes the commissioner of the PCN, with huge implications for the relationship between the two.

Another lever neighbourhoods may have is management, operating at a neighbourhood level across all of the different provider organisations.  While the role of this management will be to enable effective collaboration across the different provider organisations, the style of management employed, in particular how directive it ends up being, will directly impact the neighbourhood PCN relationship.

What is clear is that while it may take one of several forms, the relationship between the PCN and the new neighbourhood will be very important.  While at present the PCN’s accountability is contractual for delivering the PCN DES, it could be that in future the PCN may have a direct line of accountability to the new neighbourhood entity.

What this in turn means is that having as much influence as possible now on how neighbourhoods develop locally should be a priority for PCNs.  Neighbourhoods are likely to develop differently in different places, as the whole ethos is that they reflect local need.  Waiting until the 10 year plan is finally published and more national clarity is provided may be too late, because by then many of the important decisions may already have been taken.