NHS England has released planning guidance for the next three years (2026/27 to 2028/29), in a move away from the traditional one-year planning guidance.  It also appears as if (although this is not explicit) this is the promised implementation plan for the 10 Year Plan.  What does it mean for general practice?

Unsurprisingly, the focus for general practice is (yet again) on access.  A new target is even introduced, “Improve access to primary care, including reducing unwarranted variation in access. Ensure 90% of clinically urgent patients are seen on the same day. We will consult with the profession on this new ambition and approach.”

Bear in mind the NHS’s recent history of consulting with the profession is not strong, with broken promises around the changes introduced on 1^st October and the lack of BMA involvement in the Carr Hill review obvious examples.

For 2026/27, ICBs are specifically instructed to “identify GP practices where demand is above capacity and create a plan to help decompress or support to improve access and reduce unwarranted variation”.   Who will actually do this (given the downsizing of ICBs) remains to be seen.

It could fall to neighbourhoods.  These feature heavily in the document, and the expectation that began in the 10-year plan that neighbourhoods will be the golden bullet to solve all the NHS’s ills continues, e.g. “The delivery of neighbourhood care has to be a priority for every leader in the NHS because it will create more space to do elective work, reduce waiting times, improve the quality of care and make headroom for leaders to focus on innovation”.

Unfortunately, as has been the case with all references to neighbourhoods so far, details about them remain scarce.  The most concrete guidance the document contains about neighbourhoods is this:

“Starting now and accelerating over the next 3 years, we want to deliver even more care in our neighbourhoods, providing more joined up care for high-priority cohorts through integrated neighbourhood teams (INTs), and make a material difference to patient experience and hospital demand. In implementing neighbourhood health, the immediate focus must be on:

• improving and tackling unwarranted variation in GP access for the whole population
• reducing unnecessary non-elective admissions and bed days from high priority cohorts – people who have moderate to severe frailty, people living in a care home, people who are housebound or at the end of life
• enabling patients requiring planned care to receive specialised support closer to home”

It remains unclear to me how the concept of neighbourhood working is expected to impact on GP access.  However, there is to be a “Model Neighbourhood Framework” which is “expected in November”.  This will “set out the definitions, goals and scope of neighbourhood health, along with priority actions for 2026/27”.  Maybe this will provide more clarity?

There will also be a “model neighbourhood health centres archetypes, which will describe different archetypes of provision of neighbourhood health services that can be used to inform the better utilisation and enhancement of existing estates, together with new-build solutions, where appropriate”.  I think this means guidance as to how the 10-year plan promise of a physical hub for every neighbourhood is to be realised, although the language used to describe it already suggests it may be less than useful.

“Archetypes” is clearly the vogue word of the moment, as also to come in November is “a system archetypes blueprint explaining the interplay of the new contract models set out in the 10 Year Health Plan (integrated health organisations, multi neighbourhood provider contracts and single neighbourhood provider contracts) and a draft integrated health organisation blueprint.”

This document characterises integrated health organisations as a contract model.  Rather than it being a goal for acute/foundation trusts to aspire to (the implication within the 10-year plan) it is now a contract.  The big question is whether this will include the funding for general practice.  What the document says is, “IHOs will work with the wider provider landscape to deliver high-quality care efficiently, including through sub-contracting arrangements and, where appropriate, delegation of commissioning”.

Does this mean sub-contracting arrangements from the acutes to general practice to fund the right to left shift of services, or acutes having a greater say as to what general practice does through its main contracts?  We don’t know yet, but it is clearly a concern.

Indeed, the big question for general practice is whether the new contract types will sit alongside the existing core contract or replace it.  A sceptic may look at the Carr-Hill review as an opportunity for the NHS to force many practices (i.e. the 50% of practices who will lose out as a result of it) to move onto whatever alternative option these contracts may present.

For general practice, then, it feels like significant changes are coming but we still don’t know what they are.  The key questions around the relationship between PCNs and neighbourhoods, and between the new contracts and the core GP contract, remain unanswered.  All eyes are on the promised November documents, although history has taught us that we rarely get straight answers, and we should not be surprised if yet more ambiguity is what we end up with.