The last couple of months have seen a huge turnover in the people of influence over general practice.  We have a new Prime Minister, a new Secretary of State for Health, and now the National Lead for Neighbourhood Health has resigned.  What will these changes mean for neighbourhoods and for general practice, and will the result be positive or negative for the service?

While it is hard to predict the exact nature of the changes that will follow, we already have some early indications of what might lie in store.  It is clear that the big priority for Andy Burnham is reforming social care.  He wants to put it on an equal footing to the NHS, so that it becomes available to all regardless of ability to pay.

While that may feel one step removed from general practice, underlying such a change is likely to be the removal of the barriers that exist between health and social care.  The new Prime Minister and the new Secretary of State for Health and Social Care Yvette Cooper were both proponents of integrating health and social care when they ran to lead the Labour party in 2015.

This is relevant when it comes to neighbourhoods.  While the basic idea of all services being coordinated together across a neighbourhood, and Labour’s push for a “neighbourhood health service”, are still popular, the interpretation of this is likely to end up with a much more inclusive approach than we are currently seeing.

Indeed, Sir Jim Mackey’s said, as reported in his recent interview with the HSJ, ”Yvette and other ministers have told me directly that they’re worried the NHS has got less good at working with councils, less good with working with partners”.

It is reported that her view is also a concern that neighbourhood teams are not having enough of an impact, particularly on specific groups like young people and the elderly, and that there is too much focus on contracts and “moving structures around”.

If we take this, alongside the lukewarm response from the service to the consultation on the proposed new contracts, and the fact that now, all of a sudden, Claire Fuller has resigned as National Lead for Neighbourhood Health, everything is pointing to what the NHS likes to call a “reset” when it comes to neighbourhoods.

Indeed, the HSJ has mused that neighbourhoods, “Could be recast around the population groups Ms Cooper has named (children and young people, maternity, frailty, older people and end-of-life care), and around government plans on social care and public service reform”.  This does feel likely.

Equally the push for new contracts may fall down the priority list.  The main response from general practice to the recent consultation, in particular from the RCGP, is that it does not make any sense to jump into the new contract models until there is evidence that neighbourhood working actually works.  It sounds like Yvette Cooper is also keen to focus on finding what makes a difference, so she may well have a lot of sympathy for this point of view.

Meanwhile, the GPC, with its new Chair Dr Claire Bannon, has succeeded in getting the government to commit to bilateral negotiations with the GPC, which is an important step forward for the service compared to where it ended up last year.  Maybe more sensible negotiations about general practice funding can follow.

Money is being taken out of the service at an alarming rate (over £100M in the last 10 months according to a GPonline estimate) via the current list cleansing drive, and this could be only a fraction of the total amount that this initiative ends up taking.  Will this money be reinvested?  The review of the Carr-Hill formula, along with decisions about a way forward, is also long overdue.  The importance of general practice having a direct input into these discussions cannot be overestimated.

Neighbourhoods, core practice funding, and negotiating a new contract are all big ticket items for general practice right now.  It feels like we are on the precipice of major changes for each.  The introduction of the new personnel has been broadly positive in this respect so far, but with the caveat that we are at a very early stage and we will have to see how this develops over the coming months.