The Neighbourhood Contract Consultation | The questions PCNs and practices should be answering

Tara Humphrey
Aug 2
6 min read

Updated: Aug 4

Here at THC Primary Care, we provide resources for primary care leaders, and this blog focuses on the consultation on proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models, published by NHS England on 16 July 2026.

We covered what is being proposed and the routes on offer in our earlier blog, The Neighbourhood Contract Consultation: what leaders are being asked to choose between. The routes, the legal entity requirement, who can hold an MNP and the fact the options cannot be taken forward in parallel are all set out there.

This piece takes a different approach, as I am posing some key questions that I feel are worth some thought.

Before we jump in, as with all my blogs, I am sharing my views based on my experiences and the conversations I am having with networks. Many of which are grappling with function and form and how to move forward when the path may not be clear.

If you, your network and neighbourhood colleagues are all singing from the same hymn sheet, this blog is not for you. The questions I am posing could help make life clearer as we wait for more guidance.

The graphic below is a summary. Keep reading for the detail.

How does it compare to what we already do?

An SNP would deliver enhanced primary medical services at neighbourhood level through an Integrated Neighbourhood Team.

Set that against what your PCN already delivers under the DES, and against the wider work you are already doing with community services, the local authority and the voluntary sector.

For some PCNs the gap between the two is small, and the contract largely formalises what is already happening. For others it is substantial.

That distance is the thing to establish, because it determines how much of this is a change of paperwork and how much is a change of operating model.

Do we have the capacity to manage and deliver things differently?

Not just whether the services are similar, but whether you have the capacity to organise yourselves to manage and deliver things differently.

Do you have the right people, with the skills, authority and credibility to lead, manage and take your network and create an effective neighbourhood provider?

Managing a network of practices and running a provider organisation that contracts with community services, the local authority and the voluntary sector are not the same job.

The good news is that consultation does recognise this. Leadership and transformation support for the neighbourhood infrastructure appears on the list of services that could be commissioned.

If you don't have the right people, there needs to be an honest reorganisation; otherwise, don't be surprised if you end up circling the same old conversations and frustrations.

Do you actually want to work differently?

Where practices do not opt in, the MNP delivers to those patients.

The MNP could be a primary care organisation, a limited partnership, a Community Interest Company or an NHS Trust.

But wanting to hold it because you do not like the alternative is not the same as wanting to hold it. A provider that takes this on mainly to keep somebody else out starts from a weak position, and the work does not get any easier for having been taken defensively.

The question worth answering is whether you want to do this and do it well, not whether you would rather it was you than them.

The SNP is not the PCN with a new name

A network is a group of practices working together.

The SNP is described as broader than general practice in who delivers.

So the working expectation shifts. Not just your practices in a room, but community services, secondary care colleagues, adult social care, the voluntary sector and the local authority.

Your footprint is agreed with local authorities and health and wellbeing boards rather than between practices.

For some PCNs that is already how things work and the contract simply catches up with reality.

For others it is a genuine change in who you are accountable to and who has a say.

It's worth establishing which of those describes you before deciding the SNP is the option that keeps things as they are, because it is not.

A PCN that struggles to organise itself will not become easier to run as a Single Neighbourhood Provider. If anything it will be harder, becuase it will have more responsibility and a longer list of things that have to be delivered together.

What about the money?

According to the guidance documents, ICBs would be required to maintain a minimum investment in the SNP equivalent to the PCN DES, including ARRS staff. NHS England has said this directly, and practices should not see a drop in funding.

However, where PCNs kept the ARRS budget centrally, they have a workforce they can direct at neighbourhood level. Where PCNs devolved the budget to practices in 2019, and plenty did, those staff have sat in practices for six years and are considered practice staff.

Moving to a neighbourhood model in a devolved PCN 'COULD 'mean asking practices to release control of people they consider theirs.

There is also no new national money, and the Medium Term Planning Framework requires ICBs to deliver a balanced or surplus position in every year from 2026/27 to 2028/29.

But Local flexibility to add funding is already happening, and if you are in an area where neighbourhood working is being invested, this should be acknowledged and celebrated, as this is not the national position.

Why the funding attached to bundled services matters

We covered the bundling of urgent primary medical care services in our earlier blog. This is about what moves with it.

The money attached to Enhanced Access may not only be paying for the service.

PCNs and federations may be top-slicing it, and where they do, that slice can fund the management capacity holding everything else together. General practice resilience, leadership, and transformation support are also on the list of services that could be bundled at MNP level.

If the service moves upwards to an MNP, any infrastructure funded by it could move too. ( Think of what happened to the Capacity and Access funding. It's a similar principle).

These questions are not only about the consultation

Capacity runs through all of it. Whether you have the right people and the right skills.

Some PCNs have already started to organise themselves differently in readiness for what comes next, and are working through these questions now.

The consultation closes on 10 September.

So wherever you are with it, the same questions stand.

How far is what you already do from what is being described, and do you actually want to be the ones delivering it?

We hope this provides some food for thought.

📅Coming this Autumn:

The Neighbourhood Contracts Clinic

Delivered by Tara Humphrey (THC Primary Care) and Ruth Griffiths (Hill Dickinson)

Join us for a practical, in-person working session focused

on the contracts PCNs are dealing with right now.

You'll work through real contract examples with a lawyer who drafts them and a facilitator who has negotiated them from the PCN perspective.

This isn't a webinar or presentation. It's an interactive session where you can bring the questions you've been meaning to ask before signing an agreement.

📍 Already attending Best Practice? The workshop takes place in Birmingham during the same week, making it easy to add to your visit.

📝 Register your interest

We're currently gathering expressions of interest before opening bookings.

Registering doesn't commit you to a place. It helps us understand demand, decide whether to run one or two sessions, and shape the final agenda.

📋 We'll cover:

✅ Where we are now with PCN contracts and what systems across the country are already doing.

✅ PCN DES Subcontracts - What you can change, what you can't, what you can draft yourself, and when legal advice is needed.

✅ Local Variation Agreements (LVAs) - When they're appropriate, what they should include, and how the remaining DES timeframe influences decisions.

✅ Data Sharing Agreements - When you need one, when you don't, and why one agreement can often support multiple services.

✅ MOUs & Collaboration Agreements - Why an MOU is only non-binding if it's written that way, and what to check before signing.

✔️ You'll leave with:

A clearer understanding of the contractual options available to your PCN.
The right questions to ask before signing agreements.
Greater confidence in recognising when legal advice is needed.

📍 Practical information

📅 Date: Tuesday 6 October

📍 Location: Birmingham city centre

🕘 Morning: 09:30–12:30🕑 Afternoon: 14:00–17:00 (same content delivered in both sessions)

👥 Maximum 16 places per session (first come, first served)

💷 £300 + VAT per person

☕ Refreshments included.

For many PCNs, this is an opportunity to discuss contractual questions with both a legal and operational perspective before deciding whether full legal advice is required.

📩 Register your interest

Complete the Expression of Interest form by Wednesday, 12 August.

Click on the button below.

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. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.

Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.