Introduction

People want health and care that is:

• easy to access
• close to home
• more joined up

Staff also want to work together more easily. But right now, services are often split across different organisations and contracts. This can make care feel confusing and hard to navigate.

People are living longer and often have more complex health needs. Too often, help only comes when problems get worse. We want to change this by:

• helping people stay well
• offering care earlier
• moving care closer to home
• using digital tools where helpful

Neighbourhood health services are a key part of the 10 Year Health Plan. They bring together people from health, local government, providers of wider services (including public health, children’s services, adult social care and housing) community organisations and civil society organisations to work as one team. This will help make care more joined up and support the changes set out above. A neighbourhood usually covers around 50,000 people.

The 10 Year Health Plan also committed to introducing new contracts based on the needs of local populations. This consultation asks for views on two new contract types that aim to make it easier to commission neighbourhood health services.

The proposals for the two new contracts we are consulting on are:

• The Multi-Neighbourhood Provider (MNP) Contract
• The Single Neighbourhood Provider (SNP) Contract

Important points

• This consultation does not propose changes to core GP contracts (General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services (APMS)), or to the core services already commissioned through them
• Both of these new contracts would be commissioned locally, not nationally
• Local organisations would decide how most services in the contracts are designed and funded
• These contracts are intended to help local commissioners put neighbourhood health services in place more easily
• Where Integrated Health Organisations (IHOs) contracts are established, contract holders would take on responsibility for resource allocation and service planning for a defined population – including for neighbourhood health services which they would likely contract for via the MNP and SNP arrangements.

What are we trying to achieve?

The new contracts aim to:

• Make services simpler and more joined up for patients
• Focus on improving people’s health and outcomes
• Allow services to be organised around local population needs
• Help local organisations work together more easily
• Support strong, sustainable GP and community services
• Make it clearer who is responsible for delivering a service or pathway

Multi-Neighbourhood Provider (MNP)

An MNP would:

• Plan and organise NHS services that include both primary medical and non-primary care elements across several neighbourhoods (usually covering around 250,000 people or more)
• Work closely with local providers, including Single Neighbourhood Providers (SNPs), GP practices, community health services and pharmacies, NHS trusts, local government services, civil society organisations and wider public services
• Manage how any incentive payments are shared across those providers
• Help make sure services are consistent and work well together
• Provide some NHS services directly.

MNPs may also create the opportunity for additional, locally agreed funding, for providers (including general practice).

There are two ways to organise MNPs:

Option 1: Coordination model

• The MNP helps organisations work together
• Existing contracts with providers stay in place

Option 2: Lead provider model

• The MNP takes full responsibility for outcomes across multiple neighbourhoods
• Existing services are brought together under one contract

Some systems may want to start with option 1, as a stepping stone to option 2, which has clearer accountability.

Single Neighbourhood Provider (SNP)

An SNP would:

• Plan and organise NHS services for local people in one neighbourhood
• Deliver enhanced primary medical care services
• Work closely with, and sub-contract to, GP practices and other local providers
• Be part of the local neighbourhood team and lead the health services within it
• Work closely with NHS trusts, community health services and pharmacies, local government, providers of wider services (including public health, children’s services, adult social care and housing) and civil society organisations to help join up care and support

The SNP model builds on current Primary Care Networks (PCNs) but aims to be:

• More focused on local needs
• More flexible in how staff and services are organised
• Broader than just general practice in who helps to deliver services via sub-contracting

SNPs may also create the opportunity for additional, locally agreed funding for providers (including general practice). 

How services could be organised in a single neighbourhood

As well as keeping the current Network Contract Directed Enhanced Service (PCN DES), there are three ways local commissioners could organise services around local needs. The options could not be taken forward in parallel, commissioners and PCNs would need to choose one.

Option 1: Use a variation of the current PCN DES

• Keep the current nationally defined PCN DES entitlements and requirements
• Allow integrated care boards (ICBs) to add local services and funding with national agreement

Option 2: Commission SNPs directly

• ICBs contract directly with SNPs
• ICBs determine local services and funding
• SNPs deliver local enhanced primary medical care in single neighbourhoods
• SNPs may sub-contract to other organisations in support of delivering those services (for example, supporting case finding for high priority cohorts of patients)
• There may still be some nationally defined entitlements and requirements. ICBs maintain a minimum investment in the SNP equivalent to the existing PCN DES

Option 3: Use an MNP model

• ICBs commission an MNP to coordinate the delivery of neighbourhood services across multiple neighbourhoods and commission SNPs to deliver services in single neighbourhoods
• ICBs contract with an MNP
• ICBs stipulate the SNPs that the MNP must sub-contract with
• The MNP then works with SNPs to deliver enhanced primary medical care or delivers the services itself if needed (i.e. there is no SNP locally, the SNP declines or is unable)
• SNPs may sub-contract to other organisations in support of delivering those services ( for example, supporting case finding for high priority cohorts of patients)
• There may still be some nationally defined entitlements and requirements. ICBs maintain a minimum investment in the SNP equivalent to the existing PCN DES
• This should create greater consistency across neighbourhoods

What services could be commissioned through the MNP Contract and SNP Contract?

Integrated Neighbourhood Teams (INTs)

Neighbourhood teams (INTs) provide joined up care and support for specified patient cohorts by bringing together relevant health and social care professionals from:

• GP practices
• community health services
• NHS trusts
• local government
• wider services (including adult social care and children’s services) civil society organisations and community organisations

By agreement with local authorities, an MNP or SNP Contract could also include direct responsibility for some services commissioned by local authorities.

As well as integrated neighbourhood teams, the new contracts could also cover (this list is not exhaustive):

• urgent general practice services outside of core hours
• proactive care for people with long-term conditions
• support and proactive care for groups with the greatest needs
• a medicines optimisation service
• support for GP practices that are struggling
• leadership and transformation support for the neighbourhood infrastructure
• shared back-office functions
• data analytics and quality improvement functions
• digital transformation and estates strategy

Procurement and fairness

We want to:

• avoid making things too complex
• make it possible for smaller organisations to hold MNP Contracts
• make sure contracts are fair and safe

ICBs would:

• choose the right providers carefully and in accordance with procurement law
• make sure, as part of the MNP selection process, that there is support from local GPs in the relevant SNPs and neighbourhoods, before awarding an MNP Contract

Next steps

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 in the year.