NHS England has published a consultation on the proposed Single Neighbourhood Provider (SNP) and Multi Neighbourhood Provider (MNP) contracts.  But what do the proposals actually mean for practices?

I think there are at least 5 practical implications of the consultation for practices, particularly in terms of what it is telling us about how the future is likely to develop.

1. Practices working together is to become more not less important in future

One of the key questions around neighbourhoods has been whether they mean the end of PCNs.  What is clear from the consultation is that these contracts are going to evolve out of and from the PCN DES.  So regardless of whether PCNs end up being called PCNs in future, practices working together in the PCN (or neighbourhood) area is going to be a key feature of the future landscape.

2. The PCN DES is going to shift from national to local, and be combined with enhanced services

The consultation presents a number of options as to how the future might develop.  Essentially, the PCN DES could continue, or the PCN DES could be merged locally with some local enhanced services to create a local version of the PCN DES, or the PCN DES could be replaced locally by a new SNP contract that uses the PCN DES as a minimum funding requirement.

We have started to see a few areas across the country, such as Kent, already adopt the option of adding local enhanced services to the PCN DES which is then commissioned locally.  Looking ahead to next year it seems likely that more areas will follow this model, with the introduction of a full-blown SNP contract unlikely to arrive until 2028.

3. More funding is going to come to practices via PCNs/Neighbourhoods

So while at present enhanced service funding comes direct to practices, in this new model at least some of it will come via the PCN/neighbourhood.  Whether this ends up being just another hoop practices have to jump through to secure practice finances, or whether it also adds more risk to that funding remains to be seen.

4. Increasing amounts of practice funding are likely to be dependent on collective PCN/neighbourhood performance

The reason the risk to enhanced service funding may go up is that the trend is for some of the contract payments to be linked to collective PCN/neighbourhood performance.  So while in an enhanced service paid directly to practices the ability to secure all of the available funding lies directly within each individual practice’s control, in the future this will not be the case.  Instead it will rely on all of the practices collectively achieving the relevant targets.

5. Internal governance within PCNs/neighbourhoods will be more important as a result

Many PCNs have internal governance agreements that have not been changed since the PCNs were first formed in 2019.  At that time PCNs were new, and most adopted the model neighbourhood agreement (or a modified version of it).  But as more resources become dependent on the way the PCN/neighbourhood functions, it becomes more important than ever that the internal governance arrangements are effective and fit for purpose, so that roles, responsibilities and rules for funding allocations are clearly delineated.