Fit for the Future Is Published — What’s New, What’s Confirmed, and What’s Still Coming: The Guide for PCN Leaders
- Mar 18
- 5 min read
NHS England published Fit for the Future: Towards Population Health Delivery Models on 17 March 2026. This is the third major policy document in a sequence that began with the Medium Term Planning Framework and the Strategic Commissioning Framework.
If you have been following our analysis of those earlier documents, this piece will tell you what has now been confirmed, what is genuinely new, and what remains open.
It also moves the picture on from the delay story. In February 2026, the HSJ reported that neighbourhood provider contracts would not arrive until 2027–28 at the earliest. That reporting was accurate at the time.
What Fit for the Future makes clear is that while the full contracts are not arriving in 2026/27, the developmental work has begun.
First-wave SNPs and MNPs are being worked with now. IHO designation is happening in Spring 2026. The architecture is being built.
Below is the Fit for the Future summary on a page, and yours to download.
Fit for the Future. What is this document, and where does it sit?
Think of it as the architecture document. The earlier guidance told us the NHS is shifting to population-based care. This document tells us how the contracts that will deliver that care are intended to work.
It should be read alongside:
The Medium Term Planning Framework, which sets planning expectations for 2026/27 to 2028/29
The Strategic Commissioning Framework, which describes how ICBs will operate as strategic commissioners
The forthcoming Neighbourhood Health Framework and IHO Blueprint - both still to come
The three contract types: now specified, not just signalled
The Medium Term Planning Framework and Strategic Commissioning Framework both introduced SNP, MNP and IHO contracts as concepts. Fit for the Future provides the first substantive description of how each is intended to work.
Single Neighbourhood Providers (SNPs)
Deliver new neighbourhood services that sit outside existing GMS, PMS and APMS contracts
GP contracts continue unchanged - SNPs are an addition, not a replacement
The SNP contract holder will need to work closely with practices in the neighbourhood
NHS England will consult on how that collaboration is structured
Multi-Neighbourhood Providers (MNPs)
Co-ordinate services across multiple neighbourhoods
Can step in to deliver where an SNP is not willing or able to
New risk-sharing arrangements are described as a mechanism to incentivise preventative care
Integrated Health Organisations (IHOs)
Hold a whole population health budget for a defined geography
Only NHS organisations may hold IHO contracts — routes exist for neighbourhood providers to partner with or form an NHS organisation over time
NHS England will designate the first wave of IHO contract holders in Spring 2026
Initially, these will be high-performing advanced foundation trusts
How the contracts fit together ICB → IHO → MNP → SNP → GP practices The populations covered by each contract type are intended to align, so that ICBs can set consistent outcomes across the full chain. |
The sentence PCN leaders should read carefully
Neither the Medium Term Planning Framework nor the Strategic Commissioning Framework names PCNs directly in relation to the new contract architecture. Fit for the Future does.
Whilst some read the GP Contract letter 26/27 and thought it started ringing alarm bells for PCNs, Fit for the Future states that NHS England will consult on how MNPs, SNPs, GMS and the PCN DES will work together, including how PCNs might evolve into SNPs.
This is not a decision. It is a consultation signal. But it is the first time the PCN DES has been placed inside the neighbourhood contract conversation rather than alongside it.
( It will be interesting to see what emerges from the PCN DES 26/27 once published.)
What this confirms from earlier analysis
In our post Is the 26/27 GP Contract the Beginning of the End for PCNs?, we examined whether the structural positioning of neighbourhoods above PCNs was a deliberate signal.
Fit for the Future confirms it is.
The neighbourhood is the organising unit — not the PCN
GP practices remain foundational, but they sit within a broader architecture
PCNs that have been building relationships and governance infrastructure are better positioned than those that have not
In our post, The GP Contract 2026/27 and the Neighbourhood Health Delay, we noted a gap between the neighbourhood health vision and the infrastructure to deliver it, and advised treating neighbourhood development as business as usual while contracts were delayed.
Fit for the Future confirms the direction has not changed, but the developmental work is now formally underway, which moves the story on from delay to actively building.
In our post Neighbourhood Governance and the Three-Tier Model, we set out a governance structure designed to separate legal accountability from neighbourhood representation.
That logic is reinforced here. Fit for the Future describes SNP contract holders needing to work closely with practices, which requires exactly the kind of structured governance we outlined.
What remains open
The document is explicit about what is still to come. PCN leaders should watch for:
The IHO Blueprint - detailed guidance on how IHO contracts will operate
Payment model detail for SNPs and MNPs, including risk-sharing and capitation approaches
The consultation on how PCN DES, GMS, SNPs and MNPs will interact
Guidance on how MNPs can be established and how the wider provider partnership relates to them
What to do now
PCNs can use what is already specified in Fit for the Future to sense-check their current governance against what an SNP or MNP contract holder would need to look like.
Colleagues in our PCN Members Club can start to use our Governance Readiness Self-Assessment, found here, which is aligned to the Fit for the Future document.
The Neighbourhood Health Framework, published on 17 March 2026, sets out the national goals against which neighbourhood health delivery will be measured and confirms the direction set out in Fit for the Future.
PCN Plus Live 2026..... Are you coming?
We’re excited to announce that PCN Plus Live 2026 is just around the corner.
This year’s event will focus on one of the biggest questions facing primary care: How do we move from networks to neighbourhoods?
Join us at PCN Plus Live 2026 in Nottingham on 22 April, alongside leaders from across the country, sharing what is actually working on the ground.
In-person and online tickets available.
About Us
THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.
Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blog posts sharing insights on primary care networks.
Check out our facilitation services here: https://www.thcprimarycare.co.uk/primary-care-network-facilitation
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