Neighbourhood Health Uncertainty: A Flexible Framework for PCN Decision-Making

At THC, we help networks work better together and provide resources to support the leadership and management of PCNs.

The focus of this resource is to help networks confidently plan their next steps regarding the neighbourhood health agenda.

Let's jump in!

The recent NHS Planning Framework introduces "Neighbourhood Health Providers" and emphasises neighbourhood-level integration, yet conspicuously omits any mention of Primary Care Networks or general practice.

Despite the fact that 42 neighbourhood pilot sites have been selected, and it appears full steam ahead with seeing how these models develop, for many, there is a sense of uncertainty about what to do next when it comes to developing their neighbourhood model.

We have put together four practical options with different risk levels, from maintaining the status quo to establishing new organisational structures, so you can assess what fits your situation and risk appetite.

Here is the summary. Keep reading for the details.

The Policy-Practice Disconnect

The NHS Planning Framework calls for neighbourhood health plans but doesn't define who will deliver neighbourhood services. Meanwhile, as noted in my collaboration with Hill Dickinson examining whether "form follows function," some PCNs across the country are grappling with their evolution.

This disconnect between formal guidance and on-the-ground reality creates a strategic decision point for every PCN and practice.

Four Pragmatic Paths Forward

So what should you do when you don’t know what to do?

1.     Maintain Current Focus

Some networks are choosing to continue delivering their business-as-usual care within existing structures.

This is a legitimate strategy. Maintaining operational stability while monitoring developments.

There's wisdom in focusing on core delivery while the policy landscape clarifies.

Even those choosing this path should stay informed about system changes that might eventually affect them.

2. Build Through Existing Frameworks 

The PCN DES and released neighbourhood guidance already provide a pathway.

Here networks are

• Segmenting their population and identifying your most complex patients

• Choosing a specific cohort to focus on

• Mapping their patient journeys and pathways

• Incorporating additional organisations into their PCN

• Testing collaborative working while improving outcomes for your most vulnerable patients

  
  

This approach uses existing structures to build neighbourhood-level capabilities without requiring new organisational forms.

3. Create Optionality 

For those ready to be more ambitious, establishing a limited company now offers strategic advantages:

• It's relatively low-cost and low-risk

• Creates the legal structure to accept contracts when they emerge

• Provides a vehicle to test governance and decision-making processes

• Allows you to pilot collaborative projects at a broader scale

• Builds evidence of your capability before you need it

This isn't about jumping blindly. It's about learning by doing, testing whether your collaborative principles work in practice.

4. Strategic Positioning Without Formal Structure 

Even without a formal organisation, you can:

• Attend neighbourhood-based meetings

• Build relationships with local system partners

• Develop your collective voice

• Articulate what primary care needs from neighbourhood models

• Shape the conversation rather than reacting to it

I also explored this in my June article for Pulse PCN, "How to become an indispensable PCN.

The Timeline Matters

We're likely to gain more clarity as this financial year draws to a close.

This natural decision point will provide clearer signals about neighbourhood provider arrangements, allowing for more informed strategic moves into 2026/27.

I don't see any need to panic if you're not quite ready today.

Finding Your Voice in Uncertainty

Regardless of which path you choose, I think it is a good idea to work out your collective position.

➡️ What does good neighbourhood provision look like from primary care's perspective?

➡️ What do you need to succeed?

➡️ What can you offer?

The system needs this bottom-up intelligence to create workable frameworks and your experience of what works and what doesn't.

In practice, the data is invaluable and should inform your local strategies.

When Leading Isn't an Option

I have not been shy in saying that not every PCN will become the lead integrated neighbourhood organisation.

Many will disagree with me, but in some areas, that opportunity may simply be off the table, whether due to local politics, existing provider arrangements, or system dynamics beyond your control.

If you can't lead, how can you support?

Being a valuable strategic partner means:

• Bringing deep knowledge of your registered population

• Offering established relationships with patients and communities

• Providing continuity of care and longitudinal understanding

• Contributing clinical expertise and a primary care perspective

• Acting as the connector between specialised services and community needs

The neighbourhood model needs strong partners as much as it needs leaders.

The Time for Strategic Thinking is Now

I do not believe the absence of formal guidance is a reason for paralysis. You could choose to look at this as an invitation to help shape what comes next.

Whether you choose to maintain current operations, work within existing frameworks, establish new structures, or position yourself as an essential partner, taking deliberate steps now positions you to thrive regardless of how policy eventually crystallises.

Struggling with Neighbourhood Conversations in your Network?

If your network’s facing unproductive meetings, unclear goals, or ongoing tension, you don’t have to navigate it alone. Our facilitation services help PCNs tackle challenging neighbourhood conversations, clarify shared purpose, and establish decision-making frameworks that work for everyone.

Facilitation Service

Click the button above or email admin@theprimarycare.co.uk to book facilitation support.