Introduction

1. People want health and care that is easy to access, close to home, and joined up around what matters to them. Staff also want to support people without being held back by organisational boundaries. Yet too often services are commissioned and delivered through separate organisations and contracts, which can feel complex and disjointed, placing the burden on people to navigate the system.

2. People are living longer, often with more complex needs, and many would benefit from care that is more personalised, coordinated and proactive. Too often, support is something people wait for, travel to and only receive once needs have escalated. Neighbourhood health services are being developed to help change this by shifting care from hospital to community, from treatment to prevention, and from analogue to digitally enabled services.

3. Neighbourhood health is central to the 10 Year Health Plan’s ambition to build a modern NHS that works for the communities it serves. A neighbourhood is a local area with services organised around a defined population; in many places, this is around 50,000 people, though footprints may vary. Integrated Care Boards (ICBs) working with partners, including local authorities and health and wellbeing boards, should agree neighbourhood footprints so NHS services, local government services, independent partners, civil society organisations and wider public services can work together through integrated neighbourhood teams to reach people earlier, help them stay well and live independently, and prevent needs escalating.

4. To support neighbourhood delivery models, the 10 Year Health Plan committed to developing new contracts based on population size. This consultation seeks views on two proposed contracting models: a Multi-Neighbourhood Provider (MNP) Contract and a Single Neighbourhood Provider (SNP) Contract. It explains the proposals and asks questions to help us understand the likely benefits, risks and practical implications, including how the contracts would interact with existing arrangements.

5. The consultation is aimed at ICBs, general practice, Primary Care Networks (PCNs), community and other providers, local authorities, patient representatives and other stakeholders.  Patients and members of the public may also wish to contribute to the consultation.

6. We recognise that responding to the consultation may require knowledge of existing contractual models.  We are engaging directly with stakeholder groups who bring existing contracting and commissioning expertise, so we can test the detail of these proposals with people who can fully explore the detail. Alongside this, we will run webinars for wider groups open to anyone who wants to understand the proposals better, regardless of their starting point. 

7. At this stage, our aim is to understand the range of perspectives on the proposed models. Responses to this consultation will inform further, detailed consultation on firmer proposals for both the Multi Neighbourhood Provider and Single Neighbourhood Provider Contracts later this year.

Context

8. Before responding, please note the important points below about the scope of this consultation and how the proposed MNP and SNP Contracts would be used:

1. The General Medical Service (GMS) Contract is not the subject of this consultation. Government policy is to keep and reform the GMS Contract. The GP Contract (GMS, Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS)) will continue to commission core general practice services
2. The proposals in this consultation are for the MNP and SNP Contracts where local commissioners will have the flexibility to define most of the content and fund locally. There is no new national funding for these contracts
3. The SNP Contract is an evolution of the Primary Care Network Contract Directed Enhanced Service (PCN DES) which local systems can take forward at their own pace.  As a result, there will be minimum funding requirements for SNPs to ensure practices do not see a drop in funding with the move to SNP
4. Where Integrated Health Organisations (IHOs) contracts are established, the contract holder will take on responsibility for resource allocation and service planning for the whole care pathway. They will support the implementation of new models of person-centred care for a defined population, including neighbourhood health services, which they will most likely contract for via MNP and SNP arrangements.

Goals of the proposed contracting models

9. The proposed optional contracting models are intended to support ICBs as strategic commissioners to commission neighbourhood health services for defined populations in a way that is simpler, more joined up and focused on outcomes for defined populations.

10. The overarching goals of the proposed MNP and SNP contracting models are to:

• enable commissioning based on local population needs, rather than relying only on nationally prescribed service specifications that may not accurately reflect local priorities or system configuration
• bring multiple elements of a service or pathway into a single contract at multi-neighbourhood level, supporting a stronger focus on outcomes, incentives, and population-level accountability while reducing duplication and service silos
• ensure that enhanced primary medical services can be commissioned alongside other neighbourhood services, where appropriate, within a single contractual framework
• enable an at-scale organisation, working closely with general practice within a neighbourhood, to coordinate the consistent delivery of neighbourhood health services across multiple neighbourhoods
• encourage sustainable primary medical services at scale, including GP-led provider organisations, which have the capability to hold and deliver population-based contracts
• support more sustainable general practice, with growth in neighbourhood-level services, clinical leadership roles, and opportunities to shape wider pathways of care.

11. Taken together, these goals reflect a shift from fragmented service-by-service commissioning towards end-to-end neighbourhood pathways, stronger accountability for outcomes, and greater local flexibility.

Overview: Multi-Neighbourhood Provider (MNP) Contract

12. MNPs will use their scale to design and co-ordinate neighbourhood health services in their footprint, which may include delivering NHS services directly at a larger scale than a single neighbourhood, or ‘filling in’ services within a single neighbourhood where it is locally agreed to be more appropriate for an MNP to deliver.  It is our working assumption that an MNP Contract, while optional, could work well at a footprint of around 250,000 people or more, but we do not propose to mandate a national size. 

13. This consultation proposes using the NHS Standard Contract with an additional “Neighbourhood” schedule for commissioning a multi-neighbourhood provider which delivers healthcare services.  The “Neighbourhood” Schedule would operate in a similar way to the existing Schedule 2L (Provisions Applicable to Primary Medical Services), enabling the delivery of single neighbourhood services discussed below. 

14. The holder of the MNP Contract would need to be a legal entity. It could be held by a single legal entity itself or a lead provider on behalf of a consortium of providers. For example, it could be held by a primary care organisation, a limited partnership, a Community Interest Company (CIC) or an NHS Trust.  ICBs would determine the length of MNP Contracts.

15. The new “Neighbourhood” schedule would allow for the delivery of enhanced primary medical services (contracted in line with new national ‘Neighbourhood Directions’), enabling commissioners to contract more easily with an MNP for services that include both primary medical and non-primary care elements. We envisage that this would include the ability to sub-sub-contract services and enable access to NHS pensions.

16. The award of an MNP Contract would need to comply with the Provider Selection Regime or other procurement law, and local commissioners would determine the most appropriate route available.

17. There could potentially be more than one MNP Contract within a single geography.  For example, one MNP Contract may be focused on 24/7 urgent general practice and another focused on coordinating Integrated Neighbourhood Teams (INTs) to deliver a service.  In this scenario the nature of the services commissioned and the number of MNP Contracts would be locally determined. This approach would need to be balanced against the risk that multiple MNPs could limit the creation of outcomes-based contracts for whole pathways. Views are sought on the preferred approach.

18. MNPs will need to have clear relationships with SNPs and GP practices so services can be delivered to the registered population across the neighbourhoods they serve. It is proposed that the primary medical care elements of neighbourhood services would be subcontracted by the MNP provider to SNPs. ICBs would stipulate the SNPs that the MNP must sub-contract with. The sub-contracting arrangements between an MNP and the SNPs will accommodate SNPs opting in or out of services over the term of the contract (at appropriate junctures), with the MNP filling in where there is no SNP or an SNP does not agree to deliver relevant services. 

How MNPs could commission Integrated Neighbourhood Teams (INTs)

19. Set out below are two options for how commissioners might commission Integrated Neighbourhood Teams (INTs) to deliver services through MNP Contracts, reflecting different starting points across systems.  We are proposing that both are available to commissioners.

Option 1: Commissioning coordination and fill in provision through an MNP

20. In many systems, resources for neighbourhood services are already embedded within existing contracts. Under this option, the ICB would commission the MNP to coordinate the delivery of neighbourhood services or INTs across existing embedded resources. Such an arrangement is likely to be subject to the Procurement Act 2023. The MNP may also deliver some neighbourhood services itself, which could bring the arrangement in scope of the Provider Selection Regime (PSR) instead. 

21. The ICB would continue to hold the contracts with providers for the existing embedded resource and the MNP would coordinate delivery, including the management of any incentive payments with existing providers.  Any variation to existing contracts would need to be considered in accordance with the relevant procurement legislation.

22. This approach would allow:

• a single accountable provider for the coordination of INTs across a defined geography
• the inclusion of outcome-based incentives, for example, linked to reductions in non-elective admissions for a frailty pathway across the whole population. Any incentives would need to be in addition to the existing contractual arrangements with providers

23. This approach does not involve waiting for the expiry or termination of existing contracts.  The NHS Standard Contract, which will have been used to commission the existing providers’ healthcare services, supports providers to collaborate with each other. 

Option 2: Commissioning through a lead provider

24. Under this option, the ICB would commission the MNP to deliver all elements of the neighbourhood services, ideally in an outcomes-based contract with a variable incentive component.  The MNP would then sub-contract with SNPs and other providers. This would allow the MNP to have full visibility and management of end-to-end pathways.

25. Under this option, the ICB would:

• wait until the expiry of, or terminate, contracts for the delivery of neighbourhood services that are currently embedded within existing community or other block contracts. This could be done by either serving notice on existing contracts under exit clauses and/or waiting for existing contracts to expire
• indicate through the procurement process when services would move under the MNP Contract (that is, when the existing contract expires)

26. This approach would enable the consolidation of different service contracts and funding streams into a single population-based contract and support a clearer line of accountability for neighbourhood outcomes.

27. We think some commissioners will want to start with option 1 and, over time, will implement option 2, but we welcome views on this.

Overview:  Single Neighbourhood Provider (SNP) Contract

28. An SNP Contract would enable the delivery of neighbourhood-level enhanced primary medical services through Integrated Neighbourhood Teams (INTs) within a single neighbourhood. The SNP Contract is intended to build on and simplify existing approaches to primary care commissioning, and (where used) would represent an evolution from the Network Contract Directed Enhanced Service (PCN DES) towards clearer neighbourhood-level contracting.

29. We do not think the PCN DES and the SNP Contract should co-exist in the same geography, as they would be likely to cover the same population within an MNP.

30. To maximise simplicity and alignment, the SNP Contract would be created based on new “Neighbourhood Directions”. These Directions would also underpin the new “Neighbourhood Schedule” within the MNP Contract, ensuring consistency and certainty in the delivery of these services.

31. SNP Contracts would be awarded to all eligible providers (which meet the eligibility criteria, which we expect will include having access to the registered patient list) who express an interest. SNP Contracts are intended to enable delivery of enhanced primary medical neighbourhood services that are not contracted for through today’s nationally determined GP Contracts (GMS, PMS or APMS).  ICBs would determine the length of SNP Contracts.

32. The SNP Contract holder would need to work closely with general practice to ensure that services are provided to all patients within the SNP’s population. Where an MNP is in place, the commissioner would mandate that the MNP sub-contracts the delivery of the neighbourhood-level enhanced primary medical services to the SNP (see ‘Commissioning SNPs and Primary Care Networks (PCNs) section). The commissioner would stipulate the SNPs that the MNP must sub-contract with. Where practices choose not to “opt into” a part of the SNP Contract, the MNP would be required to deliver those services to patients. Practices would have the ability to exit and join SNPs at defined times, and the MNP would enable this. 

Commissioning SNPs and Primary Care Networks (PCNs)

33. We propose three broad options for commissioning neighbourhood services in a single neighbourhood, reflecting local circumstances and preferences. These would be in addition to maintaining the existing PCN DES which would still be available. The options could be sequential, or systems could choose to move directly to Option 2 or Option 3. The options could not be taken forward in parallel, commissioners and PCNs would need to choose one.

Option 1: ICB commissions a local service specification through PCNs

34. With the agreement of PCNs, ICBs would request national approval to vary elements of the PCN DES to better reflect local priorities. PCNs within the ICB area would have the option to sign up for the local variation, and the ICB would need to ensure full population coverage for any additional services.  ICBs would be required to maintain a minimum investment equivalent to the PCN DES (including Additional Roles Reimbursement Scheme (ARRS) staff), while having flexibility to include additional services for additional funding and to adjust some of the currently nationally defined PCN processes.

35. This approach would be a continuation of the arrangements introduced into the PCN DES from 1 May 2026, which allow ICBs to make requests to NHS England to vary the contract locally.  

Option 2: ICB commissions each SNP

36. ICBs would use the SNP Contract to commission enhanced neighbourhood-level primary medical services directly from SNPs. Practices in the geography would stop delivering the PCN DES and voluntarily switch to the SNP Contract.  ICBs could choose to run the SNP Contract over multiple years unlike the PCN DES which is an annual contract. 

37. Initially, some existing PCN DES requirements could remain mandatory within the SNP Contract (for example, those that keep practices working together), and ICBs would be required to maintain a minimum investment in the SNP equivalent to the PCN DES (including Additional Roles Reimbursement Scheme staff).

38. Commissioners would have flexibility to locally increase the scope and value of services commissioned through the SNP Contract, including through the inclusion of additional locally commissioned services and associated funding, without requiring national approval (as would be the case under option 1). Examples could include combining locally commissioned enhanced primary medical services within the SNP Contract, adding other services commissioned to support the development of neighbourhood health services, and variable or incentive funding.

39. We propose that the Neighbourhood Directions would establish how providers would be eligible for the SNP Contract (they would need access to the registered patient list) and set out that services must be delivered to the SNP population.  The holder of the SNP Contract must be a legal entity, although, for example, it could be held by a lead practice on behalf of a consortium of practices. There would be no requirement for practices to form separate legal entities if they do not wish to do this.

Option 3: ICB commissions the MNP and the MNP subcontracts to SNPs

40. ICBs would commission an MNP to coordinate the delivery of neighbourhood services across multiple neighbourhoods.  The MNP may also deliver some services itself. 

41. The MNP would be mandated to sub-contract the neighbourhood-level primary medical services using the “Neighbourhood Schedule” arrangements to SNPs as above.  Where practices choose not to “opt into” an SNP service, the MNP would be required to deliver the services to patients.  Practices would have the ability to exit and join SNPs at defined times, and the MNP would enable this. 

42. As with option 2, there would be a minimum SNP funding requirement equivalent to the PCN DES (including Additional Roles Reimbursement Scheme staff). This option would enable lower contracting effort for ICBs (as they would be contracting with one MNP rather than multiple SNPs) and would create a mechanism to commission an MNP to work with SNPs to deliver outcomes, potentially with incentives, across multiple neighbourhoods.  This, in turn, would encourage MNPs to support all SNPs to deliver.  A form of sub-contract would be provided which MNPs must use with SNPs.

43. Where an MNP has a PCN within its geography (rather than a SNP), the MNP would be able to sub-contract the delivery of enhanced primary medical services to PCNs.

Commissioning other services

44. This document focuses on the commissioning of INTs to deliver services to specific cohorts of patients, but there are a range of other services we could see being commissioned to support the development of neighbourhood health services.  We would expect most of these to be commissioned from MNPs (where they exist) working with SNPs (i.e. option 3 above).

45. Where additional services are envisaged for delivery by an MNP over the term of the MNP Contract, the scope of the procurement of the MNP provider would include these at the outset.  This would mitigate the need for multiple, fragmented procurements and ensure that neighbourhood services can commence quickly instead of waiting for all relevant contracts to expire (or be terminated).

46. Alongside INTs for a range of cohorts, other example services that could be commissioned include:

• Urgent primary medical care services: a bundling of PCN Extended Access, GP out of hours, 111, minor injuries and/or Urgent Treatment Centre (UTC) into one contract with potential for outcomes-based incentives on non-elective activity or a year of care contract
• Outpatient services: the coordination and delivery of neighbourhood services for long term conditions with care delivered by both primary and secondary care with potential for incentives based on shift in activity from secondary care or a year of care contract
• Medicines: a medicines optimisation service to improve prescribing quality which could include risk or gain share
• General practice resilience: the commissioning of a support service for practices that are struggling to deliver their core contract, or to deliver back-office and data analytics functions
• Leadership and transformation: support for the neighbourhood infrastructure, particularly as neighbourhoods grow in services.

Procurement, proportionality and safeguards

47. Alongside contractual changes, we want to ensure procurement and contracting arrangements are proportionate to the size and risk of any service bundle.  We hear from GP-led organisations, federations or other smaller providers that they fear the use of the NHS Standard Contract would place undue burdens on them, even where they may be able to hold and deliver the MNP Contract. We want to make sure requirements placed on potential providers are (i) consistent with the Provider Selection Regime (PSR) and other procurement law; (ii) designed to include appropriate safeguards and (iii) do not place unnecessary barriers in the path of smaller providers.  

48. Commissioners would need to run procurement processes that are proportionate in terms of assurance and bureaucratic burden so as not to disadvantage smaller providers. 

49. Commissioners would also want confirmation, when procuring an MNP Contract, that local GP practices in the relevant SNPs and neighbourhoods support the MNP. Commissioners are likely to require evidence of support from a minimum proportion of practices as part of the MNP Contract procurement process.

50. Our aim is to remove unnecessary barriers to integrated commissioning while maintaining appropriate safeguards. We would welcome perspectives on what gets in the way today, and how we could support and guide commissioners towards a fair, simple but sufficiently robust procurement process.

Next steps

51. This consultation will run until 10 September 2026. If you have any questions about this consultation or the information it contains, please contact: england.mnpcsnpcconsultation@nhs.net.

52. Feedback received on the proposed contracting models will be reviewed and consideration given to what changes (if any) should be made to the proposals. There will then be further consultation periods on the proposed final detail of both the MNP Contract and the SNP Contract later this year.