Should Form Follow Function or Function Follow Form when it comes to PCNs and Neighbourhood Teams?

"Should form follow function, or function follow form?"

It's one of those phrases we all throw around in strategy meetings and organisational development discussions. But when you look at the NHS's 10-year health plan for England, this question becomes anything but academic—especially if you're a primary care network trying to work out what you're supposed to become.

Defining Our Terms

Before we go further, let's be clear about what we mean:

Form = the organisational structure, shape, and design 

• How teams are organised

• Reporting relationships

• Size and boundaries of units

• Governance arrangements

Function = what the organisation actually does and how it operates 

• The activities and services delivered

• How work gets done day-to-day

• Roles and responsibilities

• Processes and ways of working

Form follows function = Design your organisational structure based on what you need to achieve 

• Example: "We need coordinated patient care → so we'll create multidisciplinary teams"

Function follows form = Work out what to do based on the organisational structure you have 

• Example: "We have neighbourhood teams → so we'll figure out what services they should provide"

Most people instinctively believe form should follow function. It seems logical—work out your purpose, then design accordingly.

The NHS 10-Year Plan: Does Function Follow Form?

Reading through the NHS plan, it appears that function follows form. The plan is explicit about the organisational structure (form) required: Integrated Neighbourhood Teams of specific sizes (50,000 and 250,000+ populations), but leaves the actual function (what they do day-to-day) largely to local interpretation.

The plan states that "local areas will have the ability both to trial new roles and to adopt existing, proven models" and gives "significant licence to tailor the approach to local need." In other words: here's your organisational structure (form), now work out what it should actually do (function).

But this creates an interesting discussion point. Is the plan really putting form first, or is there a deeper functional logic driving the structural choices?

The PCN Evolution Question

The neighbourhood model is very clear about the form (structure) of organisation required to deliver care. But there hasn't been explicit conversation about what happens to PCNs.

The expectation seems to be that they will "naturally evolve."

The tension that PCN leaders are grappling with right now is: Will PCNs evolve based on their current function (what they do well), or will they be reshaped to fit the new organisational form (neighbourhood teams)?

If it's function-driven evolution, PCNs might organically develop based on what they're already good at, their existing relationships, capabilities, and local knowledge.

If it's form-driven transformation, PCNs will need to reshape themselves to fit the predetermined neighbourhood team structure, regardless of their current strengths or local circumstances.

Why This Matters Right Now

If function follows form: 

• PCNs need to prepare for restructuring to fit predetermined neighbourhood team models

• Success will be measured against standardised neighbourhood team criteria

• Local variation will be constrained by the specified organisational structure (form)

• Even "divorced" PCNs will likely still need to work together as neighbourhoods

If form follows function: 

• PCNs can build on their existing strengths and relationships

• Evolution can be organic and locally appropriate

• Different models could emerge based on what works in practice

The Broader Implications

This pattern of clear organisational form with unclear evolutionary pathway appears throughout the NHS plan.

It suggests a particular approach to large-scale change: specify the destination structure but let local systems work out how to get there.

The advantages: 

• Provides clear direction and accountability

• Allows for local adaptation within defined parameters

• Enables learning and iteration during implementation

The risks: 

• Creates uncertainty for existing organisations

• May not utilise existing strengths and relationships effectively

• Could lead to inefficient or disruptive transitions

The NHS plan suggests that strategic decisions benefit from form following function (evidence-based structural design), whilst operational decisions benefit from function following form (adaptive implementation within given structures).

This might be a more useful way to think about organisational design: not as a binary choice between two principles, but as a conscious decision about where to apply which principle for maximum effectiveness.

However, perhaps more interesting questions aren't whether form should follow function or vice versa, but: At what level of the organisation should each principle apply? Or do we need to create a new organisation to support this evolution?

Legal and Organisational Perspectives

To explore the practical legal and organisational implications of this choice, we spoke with Ruth Griffiths from Hill Dickinson, who works with primary care networks navigating these exact decisions.

The Reality of Form Driving Function

Ruth commented: "When you combine the lack of detail in the 10-year plan so far, with the timescales being set for change, it is inevitable that form will start to drive function".

"Our PCN clients want to and need to be planning now for what is coming next, so we are advising them based on the solid 'knowns' and educated guesses when it comes to the 'unknowns,'" Ruth confirmed.

PCN Evolution and the SNP Contract

"We have been told that, from a PCN perspective, what is coming will build on what has come before, suggesting an evolution of the PCN model, and it appears that it will be the new SNP contract that, for PCNs, will set the rate of evolution".

"Any new contract will, unless a change is made to primary procurement legislation (which isn't suggested in the Plan), need to be procured."

"The Plan and our intel suggest that the new SNP contract will be commissioned 'top-down' by ICBs in contrast to the current PCN DES that comes in 'bottom-up' bolted on to practices' core contracts with an obligation to deliver at a PCN level."

Creating the Right Form to Secure Function

"Knowing how this new contract can be commissioned, e.g. direct award using the Most Suitable Provider exemption or competitive tender, we can inform how best to ready yourself as a PCN to respond to this opportunity.

Yes, this is form leading function, and is often met with cynicism when suggested by a lawyer, but there is something to be said, given the circumstances in which we are all working, for creating the form that will enable you to secure the function," observed Ruth.

The MNP Contract: Don't Lose Sight of the Bigger Picture

"This, for me, feels even more acute at the MNP contract tier".

An early observation Ruth shared is that many practices and PCNs are focused on the SNP contract and 50k tier of activity. General practice cannot afford to lose sight of the opportunities, and risk, associated with the MNP contract/functions.

General practice across each ICB Place needs to come together and agree as a collective on who and how it will support general practice at the MNP table. We do not know exactly the function of the MNP contract, but we do know how it can be commissioned and who the likely interested provider parties will be.

"Some are fortunate in having an existing form, by way of a federation, that can step up to this role; others have more work to do. Again, it is form driving function, but even more so at the MNP tier, you need to secure that seat through the right form, at the very least for general practice, to be able to be party to the setting of the function," Ruth said.

Flexibility for the Future

Ruth's closing remark: "The form you choose now, be that SNP or MNP tier, does not need to be final.

There are models available that have the flexibility to evolve with you as your organisation matures, your membership grows, and as the detail comes in from the centre.

We are working with clients to map out where they ultimately want to get to and then building in stages of development to their form to improve their chances of reaching that final destination."

Ruth Griffiths leads primary care contracting and corporate structuring at Hill Dickinson and can be contacted here: ruth.griffiths@hilldickinson.com

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 blogs sharing insights about primary care networks.

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