A “Planning framework for the NHS in England” was published on 8^th September.  Apart from serving as another reminder as to the benefits of the independent contractor status of general practice, which shields it from much of this top-down bureaucracy, it is also important in giving us a sense of where general practice fits into the new world of Neighbourhoods.

Unfortunately, what becomes immediately clear is that general practice does not currently feature in the NHS planning mindset.  It does not receive a single mention in the document.  This becomes all the more stark as the document explicitly mentions the voluntary, community and social enterprise sector (VCSE), the independent sector, and local authorities as “system partners” with whom formal arrangements should be put in place by the NHS to support effective planning, but there is no mention of general practice.

It could be that general practice is intended to be included in the general catch-all “place partners”, whose role is to, “lead the co-design of integrated service models at place level; and develop the Neighbourhood Health Plan and supporting place-based delivery plans”.

Maybe.  But when it goes on to talk about the production of Neighbourhood Health Plans it says that they, “will be drawn up by local government, the NHS and its partners at single or upper tier authority level under the leadership of the Health and Wellbeing Board, incorporating public health, social care, and the Better Care Fund. The plan should set out how the NHS, local authority and other organisations, including social care providers and VCSE, will work together to design and deliver neighbourhood health services. DHSC will publish separate guidance to support their development.”

The omission of general practice is stark.  Everyone else gets a mention but not general practice.  Is it an oversight or is it deliberate?

This is a difficult question to know the answer to.  It feels deliberate because of the explicit mention of everyone else.  It certainly does not give the sense that the NHS wants general practice to be in the driving seat when it comes to Neighbourhoods, which will only add to the existing concerns about the proposed new Single Neighbourhood Provider and Multi-Neighbourhood Provider contracts.

Whatever the answer, at this nascent point of Neighbourhood development it will not serve general practice well to be distant from the production of these Neighbourhood plans.  If general practice wants to play a leading role in Neighbourhoods, then it needs to position itself at the forefront of the development of these plans.  Otherwise there will be a vacuum that others will inevitably fill.

Within the NHS, place-based boards have the lead responsibility for Neighbourhood plans.  So practically speaking the best action for general practice to be taking right now is to ensure their involvement via any place-based board discussion on the topic, and to make sure they have some representation on the Health and Wellbeing Board who have been assigned a leadership role in the production of the plans.

Leadership responsibility for drawing up the plan is not the same as leadership responsibility for the Neighbourhood itself.  However, being absent from the plan production will inevitably work against general practice establishing itself as Neighbourhood leaders.