Dr Katie Bramall, Chair of the GPC, recently referred to the “vacuum” of neighbourhoods.  This certainly struck a chord.  Why is it that the flagship policy of the NHS 10-year plan has become such a dead zone?

There is undoubtedly huge frustration within general practice with neighbourhoods.  It is hard to understand exactly what they are and how they fit into the NHS infrastructure, and they are serving to create high levels of uncertainty without (so far) offering anything of benefit.

Neighbourhoods arrived along with the Labour government, as it proclaimed the NHS was to become a “Neighbourhood Health Service”.  Was that just a catchphrase, a play on letters? When the 10-year health plan arrived it seemed not, as new single and multi-neighbourhood provider contracts were also announced that would put meat on the bones.

This was followed up by the announcement of the National Neighbourhood Health Implementation Programme, but following the initial scramble to participate in this there has been virtual radio silence, both from the programme itself and on neighbourhoods more widely.

The medium term planning guidance in October promised information both on neighbourhoods and on the new neighbourhood contracts in November.  But now here we are in February and according to the GPC we should not expect anything before April.  Does this mean the contracts may not actually materialise?

Some fuel was poured on this particular fire by Robert McCartney at Hempsons, who noted a change to the NHS standard contract which in effect means that the multi-neighbourhood provider contract can be implemented via a variation to an NHS Standard Contract.  This would already limit its availability to NHS providers and the (small number of) GP federations that hold an NHS Standard Contract (which doesn’t bode well for general practice).

But this is the problem.  In the absence of any direct information about neighbourhoods (what they are, what they are supposed to achieve, how they will be funded etc etc) then all we are left with are rumours and whispers that just create anxiety.

One particular such concern is what neighbourhoods will mean for PCNs.  Could they mean that general practice will lose control of PCN funding (a move that could effectively bankrupt the majority of practices)?  Will the PCN DES, and maybe even other enhanced services, become swallowed up into neighbourhoods and neighbourhood contracts?  What does all this mean for practice autonomy?

Will neighbourhoods even be funded?  The track record so far on that front is not great.  PCNs in many areas are being exhorted to pursue neighbourhood pilots, without any real funding or clarity on what success would look like.  At present this is the most tangible reality of what neighbourhoods actually are, and so they increasingly feel like just another commissioner driven drain on resources.

It is not just about the funding and the contracts.  The vision of what neighbourhoods are and what they are supposed to achieve in the new NHS is being lost (if it ever existed).  The bold proclamations of the NHS Plan have not been followed up.  This is why neighbourhoods feel like a vacuum, because they are (at present) a concept that sucks attention, resources and focus without giving anything, not even hope for the future, in return.