GP contracts must change to enable ‘neighbourhood’ working, argues report

The way GP services are contracted must change in order to deliver the Government’s plans for ‘neighbourhood healthcare’, new research has claimed.

In a report on neighbourhood working, the NHS Confederation argued that it ‘does not mean shifting a medical model into communities’, and instead requires more focus on community initiatives and assets. 

The report said that health secretary Wes Streeting’s goal to shift more care into the community will fail unless there is a ‘more fundamental transformation of relationships’ between NHS services and communities. 

On general practice, the NHS Confed found that there is ‘significant variation’ in the capacity of individual practices or PCNs to enable genuine ‘partnership working with communities’.

It said: ‘Some PCNs report they are doing this already, and our case studies highlight examples where this is happening.

‘However, enabling GPs and wider professionals to engage and work more proactively with their communities will require changes to how primary care services are contracted, funded and assured, to unlock capacity and optimise at-scale provision/expertise in primary care.’

According to the NHS Confed, the ‘future of primary care is intrinsically linked to the neighbourhood agenda’ and in some areas, the GP practice is the ‘only community asset left’.

While the report does not set out details of any new contracting models for general practice, it does reference the Fuller stocktake as a ‘clear starting part’ for the Government’s ‘aspiration to develop neighbourhood health and care services in England’.

The report said: ‘Our work suggests that the support to change lives effectively exists in our neighbourhoods, but only if public sector resources and community assets can be brought together in the right way.’

The Fuller report, published in 2022, recommended enabling primary care in every neighbourhood to ‘create single urgent care teams’, and also for PCNs across England to evolve into ‘integrated neighbourhood teams’ which bring community providers together.

Lord Ara Darzi’s recent review of the NHS, which was commissioned by the Government, found that ‘spending in primary and community settings had a superior return on investment’ compared to acute settings, and resources should therefore be shifted in that direction.

Following this, the RCGP argued that the Prime Minister’s plans to shift care into the community should include the ‘co-location’ of GP practices with other services.

But RCGP chair Professor Kamila Hawthorne pointed out that this should not necessarily take the form of a ‘massive polyclinic’, referring to Lord Darzi’s failed plan to expand GP services under the previous Labour Government.