The 10 Year Health Plan has finally been published.  While the plan is about the NHS as a whole, it is clear that a key component of the plan is a “fundamental reform” of general practice,

“However, truly revitalised general practice will depend on more fundamental reform. Having served us well for decades, the status quo of small, independent practices is struggling to deal with 21st century levels of population ageing and rising need. Without economies of scale, many dedicated GPs are finding it difficult to cope with rising workloads… Where the traditional GP partnership model is working well it should continue, but we will also create an alternative for GPs. We will encourage GPs to work over larger geographies by leading new neighbourhood providers. These providers will convene teams of skilled professionals, to provide truly personalised care for groups of people with similar needs.” (30)

While the plan is rarely explicit about the reform it will impose on general practice, and seems to go to great lengths to be careful in the language that it uses (doubtless because having GPs on board will be crucial to the plan’s success), change to general practice sits at the heart of this plan.

General practice will no longer operate as standalone organisations, but as components of neighbourhoods.  This is a huge change.  While practices have had to work together as part of the PCN DES in recent years, it has for the most part been joint working around the edges.  The core business of the practice has always been separate and remained clearly within the domain of the practice.

This plan is clear that practices will operate as part of the incoming neighbourhoods.  Improving access to the practices within the neighbourhood is a priority part of the neighbourhood activities.  The NHS App will be enhanced to take on much of the first contact work that practices currently undertake.  The work of neighbourhoods will not be restricted to practices activities outside of core work.

A large part of practice funding will come via the neighbourhood.  While core funding will still come direct to the practice, it very much appears that all other funding – local enhanced services, PCN DES funding (or whatever that becomes), vaccination and immunisation funding, potentially even QOF funding, along with any new money – will come via the neighbourhood.  Neighbourhoods will be impossible for practices to ignore.

Neighbourhoods, in turn, will be run by at-scale organisations.  In the best case scenario they will be run by groups of practices working together as an entity, either an enhanced PCN-type organisation or federation.  But the plan is clear that neighbourhoods will not solely be in the domain of general practice, “We will also give integrated care boards (ICBs) freedom to contract with other providers for neighbourhood health services, including NHS Trusts” (32).

Those running neighbourhoods will be those who are awarded the two new contracts the plan introduces – the single neighbourhood provider, and the multi-neighbourhood provider.  It appears both contracts can be operational in the same area, with multi-neighbourhood providers, “responsible for unlocking the advantages and efficiencies possible from greater scale, working across all GP practices and smaller neighbourhood providers in their footprint” (32). Both, it seems, will be directly involved in the work and functioning of individual practices.

Part of the plan is also to reinvent Foundation Trusts.  Its intention is to, “Create a new opportunity for the very best FTs to hold the whole health budget for a defined local population as an integrated health organisation (IHO). Our intention is to designate a small number of these IHOs in 2026, with a view to them becoming operational in 2027. Over time they will become the norm” (13).  It very much seems, then, that the plan is for these two new contracts to ultimately be commissioned by these FT-run “integrated health organisations”.

So the plan seems to herald the end of the independent contractor model for general practice.  While practices can remain contractors, it does not seem that they will be able to remain independent.  Instead, they will become part of the fabric of the new neighbourhoods, with a whole series of new masters (the single neighbourhood provider, the multi-neighbourhood provider and the integrated health organisation).

There is opportunity in the changes for general practice, but there are also huge risks, not least of which is the opportunity for NHS Trusts to gain such direct influence and even take over GP practices.  The status quo, however, does not feel like it will be an option, and so active involvement in shaping the changes as they occur must become a top priority for practices.