Neighbourhood Health Framework and Population Health Delivery Models

This resource outlines the changes, risks and concerns associated with the Neighbourhood Health Framework and related Population Health Delivery models, which set out a proposed direction of travel for the NHS

Overview

The Neighbourhood Health Framework and associated population health delivery models set out a proposed direction of travel for the NHS, rather than immediate change. They signal a shift towards care delivered closer to home, with a stronger emphasis on prevention, alongside the development of new provider structures intended to coordinate services and hold budgets. GP contracts are expected to remain, but increasingly within wider system arrangements.

While development is anticipated over the next two to three years, these proposals represent a longer term change in how care may be organised and funded. Although the ambition is improved integration and population health outcomes, there are material risks for general practice, particularly in relation to workload, professional autonomy and resourcing.

Practices should remain informed and engaged, but also appropriately cautious as further detail and implementation plans emerge.an immediate change, with development expected over the next 2 to 3 years.

Neighbourhood-based care

Care will be organised around defined neighbourhood populations, typically aligned with groups of practices, with integrated teams across general practice, community services and mental health.

New provider structures

  • Single Neighbourhood Providers: delivering services within a local neighbourhood
  • Multi-Neighbourhood Providers: coordinating services across several neighbourhoods
  • Integrated Health Organisations: holding budgets for a whole population and overseeing service design and delivery

Strategic commissioning

Integrated Care Boards (ICBs) will focus on outcomes and commissioning at population level, rather than managing individual services.

GP contracts

Core GP contracts (GMS, PMS, APMS) remain nationally determined. However, new neighbourhood services are likely to sit outside core contracts.

Closer working with other services

Practices are likely to be increasingly involved in multidisciplinary neighbourhood teams and collaborative service delivery.

Expansion of services outside core contracts

Additional services may be developed at neighbourhood level, potentially involving practices but not necessarily delivered under GMS or PMS arrangements.

Changes to local system relationships

Larger provider organisations, such as trusts or alliances, may take on greater roles in coordinating care and holding budgets.

Evolution of PCNs

There are indications that Primary Care Networks may evolve or be replaced by new neighbourhood-level provider arrangements over time.

Workload shifting without resource

There is a real risk that expectations move into general practice ahead of funding, workforce or infrastructure. This has been a recurring pattern in previous system changes.

Loss of autonomy and influence

Although GP contracts remain, practices may find that decisions about service design, priorities and pathways are increasingly made at neighbourhood or system level.

Provider-led system control

Integrated Health Organisations are likely, at least initially, to be led by larger NHS providers. This may shift influence away from primary care unless governance arrangements are robust.

Unclear accountability

As services are spread across multiple layers, there is a risk of confusion about who is responsible for what. This can create operational pressure at practice level, particularly when patients default to general practice.

Financial and clinical risk transfer

Population-based budgets and risk-sharing arrangements may place pressure on providers to reduce activity. Without careful design, this can translate into indirect pressure on practices.

Erosion of existing structures

PCNs and other current arrangements may be reconfigured or replaced. The implications for funding, workforce and leadership are not yet clear.

Variation between areas

As these models are described as “locally led,” implementation is likely to vary. This may lead to inconsistent expectations and support across different systems.

  • How funding will shift in practice from hospital to community settings
  • How new provider arrangements will interact with existing GP contracts
  • Whether and how PCNs will formally transition into new structures
  • The extent to which practices will be expected to participate in new delivery models
  • How financial and clinical risk will be shared across the system

Stay grounded in your core contract

Your GMS, PMS or APMS contract remains the foundation of your work. Any additional activity should be clearly defined and funded.

Be cautious about informal expectations

If new responsibilities are suggested without clear agreement or resource, it is reasonable to seek clarification before proceeding.

Engage collectively

Work through PCNs and LMCs to ensure a coordinated primary care voice in local discussions.

Ask practical questions

When new models are proposed locally, ask:

  • What exactly is being asked of practices?
  • What funding and workforce are attached?
  • Who is accountable for delivery and risk?
  • How does this sit alongside existing contractual obligations?

Escalate concerns early

If there is uncertainty or pressure to take on new work without clarity, seek advice early.

LMC support

The LMC is engaging with these developments at system level and will provide further updates as local plans emerge.

We recognise that these proposals are already generating concern. Our role is to ensure that general practice is not expected to absorb additional workload or risk without appropriate funding, clarity and representation.

If practices are asked to participate in new neighbourhood or population-based arrangements and are uncertain about the implications, please seek advice.

For those who would like to explore the detail behind these proposals, the following documents set out the national policy position and proposed delivery models:

  • This document outlines the vision for neighbourhood-based care, including the role of integrated neighbourhood teams and how services are expected to be organised locally.
  • This document sets out the proposed contracting and delivery structures, including Single Neighbourhood Providers, Multi-Neighbourhood Providers and Integrated Health Organisations.

These documents are high-level and describe direction of travel rather than final implementation detail. Local interpretation and application are likely to vary, and further guidance is expected over the coming months.