GP leaders need to actively and ‘decisively’ design the model for neighbourhood health working or risk reforms failing and contracts being written ‘around them’, the BMA has warned.
The GP Committee England issued guidance last month to general practice organisations that work at scale, such as GP federations, PCNs, PCN alliances and super partnerships, urging that they ‘need to lead or be led’ – and take action now before the new neighbourhood health service contracts are published.
It described the Government’s reform agenda as ‘strategically correct’ and neighbourhood health as the ‘right answer’ but said that without urgent intervention from GP leaders, it will just become a ‘new applied label to old system dynamics’, with hospitals retaining control and no meaningful change towards preventative and patient-centred care.
As part of the 10-year plan launched last year, two new contracts are being introduced to encourage GPs to work across larger areas and lead neighbourhood health services that aim to shift care away from hospitals and into the community. Pilots were announced last September in 43 areas.
However, GPs raised concerns about whether general practice will be leading neighbourhood services, as some locations had appointed hospital trusts to head up the project.
There is a ‘strategic risk to general practice’, the GPC England explained, if GP organisations remain passive on this, highlighting that neighbourhood contracts could be hosted elsewhere; budgetary control will consolidate upstream; general practice will carry clinical risk without financial leverage; and access targets will ‘crowd out prevention and complex care.’
And it warned that action to prevent that has to be taken soon ‘before behaviours, contracts and expectations become locked in’.
It added that ‘waiting for…contracts to appear is not strategy and is unwise. Design the model before it is handed to us as a contract.’
To ensure neighbourhood working is effective, the BMA has called on GP organisations to:
- Lead on its design
- Demand transparent reinvestment
- Insist on enforceable rules
- Align with system partners willing to share risk.
It also set out ‘non-negotiables’ that should be set out when engaging with ICBs and other system partners (see box below).
And GP neighbourhood leaders must speak fluently in system finance – not just clinical outcomes, the union has said, as well as position general practice organisations as having proven ability to deliver population health management, co-design services with patients and communities, manage multi-sector budgets and work across sectors.
‘General practice has already proven its productivity and fiscal discipline. It is neither radical nor unreasonable to argue that the most efficient sector of the NHS should shape the future model’ the guidance said.
‘When a sector delivers extraordinary value, it must diversify and lead – not defend and shrink.
Neighbourhood health is the largest structural shift in NHS delivery since the 2012
reforms. If GP-at-scale structures do not seize this moment, contracts will be written
around us.’
The document concluded: ‘This is likely the last realistic opportunity to intervene before behaviours, contracts and expectations become locked in. Left shift will not happen through goodwill, it will
only happen through design. We need to lead or be led.’
The guidance has been released as part of the BMA’s ‘Critically endangered – facing extinction’ campaign, which underlines the need for a new substantive GMS contract, stable funding in general practice and workload safeguards.
Non-negotiables for GP organisations in shaping neighbourhood health
When engaging ICBs and system partners, the following should be treated as red lines:
1. Defined, limited, patient-focused outcomes – not locally negotiated metrics that protect incumbent income.
2. Mandatory, protected budget envelopes at place – optional devolution equals stalled reform.
3. Full financial transparency – all neighbourhood flows traceable. No opaque cross-subsidy.
4. Identical behavioural rules regardless of host – acute, community or primary care, there should be same standards.
5. Prohibition of profit extraction from neighbourhood budgets – public money must be reinvested in public value.
Source: BMA
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