Neighbourhood Working | Must dos, Could dos, Trade-Offs and Risks

2 days ago
4 min read

At THC Primary Care, we provide resources to support the leadership and management of primary care networks.

In this blog, we summarise our recent YouTube Live session with Ben Gowland, Dr Andy Foster, and Dr Hussain Gandhi.

This conversation has become something of a yearly tradition, where we come together to discuss the news stories affecting primary care in the run-up to our national conference, PCN Plus Live, taking place on 22nd April.

If you want the full discussion, you can watch it on YouTube here. What this blog adds is my own reflection on what was discussed.

What we covered

The session landed on a busy day.

➡️ The BMA ballot had returned a 99% vote to reject the proposed 2026/27 GP contract.

➡️ The DDRB had recommended a 3.5% pay uplift for GPs with no assurance it would be met.

➡️ The new PCN DES contract specification for 2026/27 was published hours before we went live.

The main focus was the Neighbourhood Health Framework published on 17 March 2026, what it means for general practice, who is likely to hold SNP and MNP contracts, and what good positioning looks like now.

Ben Gowland, as always, was his candid self, and he described himself as still in the angry phase, and we did agree there was value in acknowledging that honestly.

The framework states that neighbourhood working will improve access to general practice, but does not clearly explain how.

I'm a bit more optimistic. My take is that there are choices to be made. If you, your practice, and your network choose to disengage, that is your choice (even if it doesn't feel like it), and I'm trying to resist making people fear the future by sharing the potential negative consequences of this.

Instead, I want people to consider:

1️⃣ What can you do with what you've got?

2️⃣ What opportunities for negotiation are there?

3️⃣ What does 1% better look like?

Four people on a video call smile and chat in separate home offices. Visible background shelves and wall art add to the cozy setting.

(I'm not sure why, Andy, Ben and I look happy and Gandhi does not 😁)

You can watch the full session on YouTube here.

What matters most right now?

In the session, I asked Andy and Gandhi what matters most to them right now. And that's not to be confused with what is being talked about the most.

I ask it because general practice is the foundation on which everything else builds. If practices are not stable, the neighbourhood agenda becomes much harder to deliver.

The answers from Andy and Gandhi were

➡️ Access. On-the-day demand, keeping online access open

➡️ Managing referral rejections

➡️ Uncertainty about the capacity and access payment shift.

➡️ The potential collective action

Neighbourhood working was present in the conversation but kept at a distance from the immediate pressure.

I would urge every PCN leader to inquire about what is currently most important to their member practices.

If you do not know the answer, neighbourhood working will always feel like something you are dragging people along, rather than something they are actively moving towards with you.

The neighbourhood agenda has to connect to the things practices genuinely care about, or it will sit alongside the day job as an annoyance rather than supporting it.

Must-dos, could-dos, trade-offs and implications

When I look at any guidance document, I find it useful to work through a simple framework.

What are the must-dos?

What are the could-dos?

What are the trade-offs?

And what are the risks, and what are the implications of those risks?

Working through these questions honestly and understanding the range of views across your network will enable you to shape a positive, powerful narrative.

Grid with four sections in teal and black. Topics: Must Dos, Could Dos, Trade Offs, Risks and Implications. Includes text with strategic advice.

It is what enables you to have strategic conversations about what you can do right now and what you cannot, taking into account everything currently on your network's plate.

Many networks are doing more than they think, and this should be recognised, and if not, let's go back to the initial questions:

1️⃣ What can you do with what you've got?

2️⃣ What opportunities for negotiation are there?

3️⃣ What does 1% better look like?

However, if you decide:

⬇️ There are no viable could-dos

⬇️ The trade-offs are too big

⬇️ The risk of doing nothing is a risk you are willing to take.

This is your decision, and I would encourage you to move forward with it rather than spending too much time explaining why you are not.

There are practices that have opted out of the PCN DES.

If you want to position for neighbourhood contracts

If holding a neighbourhood contract is something your network wants to work towards, there is one thing worth thinking about now.

Convening the conversation is not enough.

Many networks are bringing people together around neighbourhood working, and that is the right starting point.

But there comes a point where convening without deciding anything starts to work against you.

People disengage when nothing gets done. When meetings happen without decisions being made, attendance drops, momentum stalls, and the people you need around the table stop showing up.

I'm not talking about legal governance here; it's just basic leadership and management.

➡️ Get clear on your purpose with the information that you have.

➡️ Get clear on the outcome you are working towards, or at least what progress looks like.

➡️ Get clear on how decisions will be made, test it, and see what works and what doesn't. This is the messy part of the learning process.

The networks that will be ready when neighbourhood contracts arrive are not necessarily the most sophisticated in legal structure. They are the ones who have practised making decisions together.

I hope this helps.