There is a misconception that somehow the new Neighbourhoods will replace PCNs.  This is not the case.  What will be of critical importance, however, will be the relationship between the PCN and the Neighbourhood.  This is likely to be determined by whoever takes on the leadership role for the Neighbourhood.

At its core a Neighbourhood is the coming together of all of the providers across a local community.  One of these providers is general practice.  Neighbourhoods will not function effectively if practices operate as individual providers, and instead need practices to operate as a collective.  This will be via the existing PCNs, as the PCN DES requires practices to work together.

But the PCN will only be one voice around the Neighbourhood table.  There will also be the community provider, mental health providers, social care, voluntary sector, other primary care providers and even the acute trust.  This group will need to decide how any new Neighbourhood services are to be designed, delivered, staffed and funded.  If this funding is to come via a new Neighbourhood contract then this group will need to agree how this funding is to be used and apportioned.

The Neighbourhood, then, will in some respects mirror how PCNs function at present where the different practices come together to make these kinds of decisions, but instead of this being a discussion between the practices it will be a discussion between different organisations and only one of these organisations will be general practice (via the PCN).

Given how hard many PCNs find it to agree decisions across their practices, the challenge facing Neighbourhoods in getting all the different organisations involved to come to an agreement should not be underestimated.

The challenge for the PCN leaders, or whoever ends up representing the PCN in the Neighbourhood discussions, will also be significant, as they will have to come to an agreement that works with the other Neighbourhood providers as well as one that the practices within the PCN will sign up to (particularly where practice delivery is involved).

The opportunity seems to exist at present for general practice via PCNs to take on a leadership responsibility within the new Neighbourhoods.  The question is whether, given the complexity and obvious challenge there will be in getting these Neighbourhoods to work, this is a sensible move?

The problem is that, like it or not, Neighbourhoods are coming.  Neighbourhood contracts are on their way, and any new funding for out of hospital care (including general practice) is highly likely to come via this route in future.  The question, then, is not really whether we like the idea of Neighbourhoods or want to work as delivery partners with our local provider colleagues, but given that Neighbourhoods are coming whether it would be better to have the leadership role or for another organisation to take this leadership role on?

When we think of it like this the answer is obvious – general practice and PCNs have to take this opportunity to lead Neighbourhoods.  The alternative of giving this up and letting others take on the leadership responsibility would allow them to determine what role general practice should play in the Neighbourhood and, crucially, what resources it should receive for doing so.

At present the importance of Neighbourhood working is easy to ignore, because the neighbourhood contracts are not yet in place and no real funding is at stake.  However, this will change in the years to come.  But the opportunity to take on the leadership role is coming now.  What PCNs and general practice must not do is give this opportunity up and let someone else take it on because it doesn’t feel important, because when the financial realities kick in in the coming years it will be too late to have a change of heart as someone else will already be in the driving seat.