While we know the impact of neighbourhoods could potentially be hugely significant for general practice and PCNs, the recently published neighbourhood health guidelines told us very little about them.  This is because the powers that be want them to be locally developed rather than nationally imposed.

But this in itself is important.  It means all of the most important decisions about neighbourhoods are going to be taken locally.  Neighbourhoods in one area could look very different to neighbourhoods in another.  The devil will be in the details.

It almost goes without saying, then, that general practice needs to make sure it is directly involved in the decision making about the local development of neighbourhoods.  According to the guidelines there needs to be, “a mechanism for joint senior leadership, such as a joint neighbourhood health taskforce, in each place to drive integrated working, comprising senior leaders from the constituent organisations across health and care, including the acute hospital”.  General practice needs to make sure it is on whatever this looks like in their local area.

But getting on this group or taskforce is only step one.  Once there, what do general practice leaders need to be seeking to influence?  Here is an initial list of 6 things to look out for:

1. The Configuration of PCNs. The Neighbourhood Health guidelines avoid the question of what the configuration of neighbourhoods should be, instead leaving this for local areas to decide.  While some areas may end up with a configuration that matches the current PCN configuration, many areas will not.  A key question will be how, then, any misalignment between the two should be handled, and whether attempts will be made to alter the configuration of PCNs as a result.

2. Control of PCN Resources. While we may see an investment in the neighbourhood infrastructure via the forthcoming 10 year plan, as it stands the current guidelines do not suggest that there will be any.  Given the lack of additional resources there is a real risk that the system will try to treat PCN resources, and in particular the ARRS staff, as neighbourhood resources rather than resources that belong to general practice.

3. Improving GP Access. It seems somewhat incongruous that neighbourhoods, that are supposedly about joint working between organisations, are to have a focus on improving the performance of one of these organisations (general practice) as an initial priority (“NHS England regional teams… should work with systems to agree locally what specific impacts they will seek to achieve during 2025/26. We expect these to include, as a minimum, improving timely access to general practice”).

One question this raises is how neighbourhoods will seek to achieve this.  The risk to watch out for is that systems via neighbourhoods may choose to adopt a top-down, performance management approach, rather than one that seeks to reduce pressure on practices by maximising the contribution of other local agencies.

4. The Role of PCN CDs. If PCNs are to form one component of neighbourhoods alongside a range of other local providers, an important question will be where PCN CDs end up sitting within the neighbourhood leadership infrastructure (if anywhere).  Will PCN CDs be able to play an influential role in shaping and leading neighbourhoods, or will the local system attempt to sideline them in favour of giving power to others?

5. The “Integrator” Function. All the indications are that an at-scale organisation will be sought to take on what has so far been termed an “integrator” function (for example in North West London – here).  This is where one organisation takes on responsibility for bringing all the providers in the neighbourhood together, which in turn could bestow considerable control of the neighbourhoods to that organisation.  While theoretically this could be a primary care organisation, a community health provider or a local authority, what is important is which of these it ends up being locally.

6. Funding Streams (and link to GP funding streams). If neighbourhoods are to have any kind of authority then they will need to have clear funding streams.  The guidelines, however, do not make clear what these will be.  The concern might be that some systems may choose to set neighbourhoods up as commissioning style organisations, that hold all of the local funding for the local providers, but with the freedom to move it around to “best meet local needs”.  This could potentially put GP and PCN funding at risk.

The other funding stream risk GP leaders will need to be aware of is where finances are predicated on a series of “invest to save” business cases, designed to shift resources from secondary care to the new neighbourhoods.  These have a terrible record of success, largely due to fixed capacity in secondary care and the ongoing increase in overall demand (Joe McManners explained this well on our podcast last year), and so such a design would most likely be setting neighbourhoods up to fail.

These are just some of the initial things for GP leaders to be looking out for.  The most important thing at this stage is to ensure that general practice is represented on the local neighbourhood development group, and that there is effective two way communication between this representation and practices and PCNs.