One of the big claims being made by the government and NHS England is that the introduction of neighbourhoods will improve access to general practice.  But how exactly will the introduction of neighbourhoods achieve such a feat?

This is a question that I don’t think is being asked enough.  It simply is not obvious that the introduction of neighbourhoods will lead to an improvement in GP access.

The idea of neighbourhoods is that they are to solve the problem of services in the community being disjointed and poorly co-ordinated.  Their development is being sold as enabling the left shift of services out of hospitals into the community.

But how does joining up services and enabling services to move out of hospital improve GP access?

Maybe the neighbourhood system will allow more resources to be invested into general practice so that improvements in access can be achieved?  As well as this sounding improbable the document makes it clear that no new resources are coming via neighbourhoods, and the chances of existing providers choosing to give their money to GP practices to improve access does not seem high.

Maybe the new Neighbourhood Health Centres are the answer?  The guidance states that these will bring GP services together “with a mix of community, local authority and civil society sector services” so that services are organised so that they can work together.  But increasing the scope of the demand hardly seems like a mechanism for improving access.  And if GP services are centralised from existing locations to these new centres (I don’t think that is the idea but you never know) then surely the extra distance will just make access worse.

Maybe it is that access to general practice is seen as a precursor to neighbourhood health?  This is implied by what the government’s framework says about it, “General practice is the bedrock of neighbourhood health. Without good access to GPs and their teams, we cannot shift the dial on outcomes, patient experience or sustainability.  As part of building a neighbourhood health service, the NHS will support GP access recovery.”

The logic that neighbourhood working requires improved access to general practice does not really stack up.  If the point of neighbourhood working is agencies working together to improve outcomes for specific cohorts of patients, then access to practices is not going to be a major factor in its success.

But we all know its political and been crowbarred in because it suits political priorities.  Even so, how will access be improved?  There is no new money being given in this year’s contract, yet it still appears as a neighbourhood priority for 26/27.

One of the “minimum basic requirements” of ICBs for this year is to “agree a plan for tackling unwarranted variation and improving access to general practice, ensuring core hours requirements as defined in the national GMS contract are met, including the newly introduced urgent access requirements”.

The plan appears to be as follows. A new non-negotiated requirement for practices to respond to urgent requests on the same day is imposed on practices without any agreement from the service, or without any additional funding.  ICBs are then expected to performance manage any practices not achieving the target.

However, ICBs have been depleted of manpower to the point where direct performance management of practices on any sort of scale seems unlikely.  This, I think, is where the new neighbourhood infrastructure comes in.

PCNs wanting to take on the new SNP contracts will almost certainly be expected to ensure that all its practices are hitting the access targets in order for their bid to be successful.  Once in place the new MNPs will performance manage any SNPs with practices not hitting the access targets.  IHOs will performance manage any MNPs with SNPs and practices not hitting the access targets.

Underneath this plan is the belief that all practices could be hitting these new targets within existing resources, and that those who are not are either not trying hard enough or have poor processes in place.  There is no recognition or understanding of the current realities of general practice, or of the hugely different circumstances that practices operate within.

I have written before about how NHS style performance management is coming to general practice.  If general practice wants to maintain the independence it currently enjoys then this is something it needs to strenuously resist.