The Neighbourhood Contract Consultation: what leaders are being asked to choose between
- Tara Humphrey
- 3 days ago
- 9 min read
Here at THC Primary Care, we provide resources for primary care leaders, and the focus of this blog is the consultation on proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models, published by NHS England on 16 July 2026.
In this piece, we cover:
What the consultation is, and what is out of scope
Broad definitions of what a Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) are
The four routes for a single neighbourhood, and why two of them are the same contract
The pros and cons of each route
What else could be commissioned, and where the money actually comes from
How to respond, and why to do it together
Let's jump in!
What the consultation is
The consultation closes on 10 September 2026, and is aimed at Integrated Care Boards (ICBs), general practice, PCNs, community and other providers, local authorities and patient representatives to share their views on the proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models.
There are three things out of scope:
The GP Contract is not part of this.
General Medical Services (GMS),
Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS)
These contracts will continue to commission core general practice services, and the document states that government policy is to keep and reform the GMS Contract.
At present, there is no new national funding for new proposed contracts.
What an SNP and an MNP actually are
A neighbourhood is a local area with services organised around a defined population. In many places, that is around 50,000 people, though footprints vary and ICBs agree them locally with partners.
A Single Neighbourhood Provider (SNP) would plan and deliver enhanced primary medical services for one neighbourhood, working through an integrated neighbourhood team and sub-contracting to GP practices and other local providers.
NHS England describes it as building on what PCNs already do, but more focused on local needs, more flexible in how staff and services are organised, and broader than general practice in who delivers.
A Multi-Neighbourhood Provider (MNP) would work across several neighbourhoods, coordinating services, managing how any incentive payments are shared, and delivering some services directly. The working assumption is around 250,000 people or more, but no national size is being set.
Neither replaces your core GMS contract, and both would be commissioned locally by your ICB.
The four routes, and why two of them are the same contract
The graphic below presents the options up for consultation.
For a single neighbourhood, NHS England sets out three options, in addition to maintaining the existing PCN DES: the Network Contract Directed Enhanced Service, which would still be available.
A system can start on option 1 and move to option 2 or 3 later, or go straight to either. They cannot be taken forward in parallel. Commissioners and PCNs would need to choose one.
Option 1 is not a new mechanism. It is the Local Variation Arrangement route already introduced into the PCN DES from 1 May 2026, which I wrote about here. The consultation describes it as a continuation of those arrangements.
Which means the four routes are really just two contracts. Stay on the PCN DES, varied or unvaried. Or move to an SNP Contract, held directly or sub-contracted from an MNP.
The first keeps the rules for enhanced primary care set nationally. The second lets them be decided locally. That is the decision underneath the options.
Considerations for each approach
Here is how the three routes compare at a glance, with the fuller considerations for each set out underneath the table. ( These are just some initial thoughts which you may or may not agree with. This list is not exhaustive.)
Staying on the PCN DES, varied or unvaried
This is the route you are on now. You keep the national PCN DES, either unchanged or with a Local Variation Arrangement added to bring in extra services and funding locally.
Entitlements and requirements are nationally defined, so you know broadly what to expect, but this may not work for your population.
It is annual, so you can reconsider each year, but this means no multi-year planning.
No new eligibility requirements.
Where a variation is used, it requires the agreement of PCNs.
National approval is required for any variation, so it is neither fast nor guaranteed.
There is a ceiling on what can be varied. As we set out in the Local Variation blog, the route only covers sections 7, 8 and 10.1 to 10.5 of the DES specification: the Additional Roles Reimbursement Scheme (ARRS) rules, the service requirements and most of the financial entitlements. It cannot vary participation rules, organisational requirements, contract management, or how the population is defined. Option 2 has no equivalent ceiling and needs no national approval.
If NHS England issues a national variation during the year, it overrides your local one, unless your Local Variation Notice has been changed to protect your position. So what you gain locally can be overwritten nationally.
Option 2, direct SNP contracts
Here, your practices leave the PCN DES and hold a Single Neighbourhood Provider contract directly with the ICB, commissioned locally rather than nationally.
A multi-year contract is possible, which supports longer-term planning.
Commissioners can increase scope and value locally without national approval, the single clearest difference from option 1.
The relationship with the ICB is direct.
SNP Contracts would be awarded to all eligible providers who express an interest, so this is not a competitive procurement you can lose (in theory).
The contract holder must be a legal entity, but it could be a lead practice on behalf of a consortium, with no requirement for practices to form separate legal entities if they do not wish to.
The funding floor is protected, but the specification is not protected.
Eligibility is expected to require access to the registered patient list.
Practices stop delivering the PCN DES, so nationally defined entitlements are traded for locally determined ones.
Outcomes will vary with ICB capability and the relationship you have with them.
Option 3, MNP sub-contracting to SNPs
Here, a Multi-Neighbourhood Provider holds the contract with the ICB and sub-contracts the neighbourhood work to SNPs, so you deliver as a sub-contractor rather than holding the contract yourself.
The same minimum SNP funding requirement applies.
A form of sub-contract would be provided, which MNPs must use, so you are not negotiating bespoke terms from a weak position.
Practices can opt out of services and can exit and join SNPs at defined times.
The MNP is incentivised to support all SNPs to deliver.
Commissioners are likely to require evidence of support from a minimum proportion of practices before awarding an MNP Contract, a meaningful lever.
It is a lower contracting effort for ICBs.
You are a sub-contractor rather than a contract holder, so your relationship with the ICB runs through the MNP.
The MNP could be a primary care organisation, a limited partnership, a Community Interest Company or an NHS Trust, and it manages how incentive payments are shared.
Where practices do not opt in, the MNP delivers to those patients.
It is the longest accountability chain of the four.
What else could be commissioned?
NHS England sets out examples of other services that could be commissioned, and says it would expect most of them to come from MNPs working with SNPs. The examples given include:
Urgent primary medical care services, described as a bundling of PCN Extended Access (what most of us call Enhanced Access), GP out of hours, 111, minor injuries and Urgent Treatment Centre provision into one contract
General practice resilience: a support service for practices struggling to deliver their core contract, or to deliver back-office and data analytics functions
Leadership and transformation support for the neighbourhood infrastructure
This is not new money. It is funding already committed to services that are currently commissioned separately, brought together into neighbourhood-level bundles.
Three of those services sit with PCNs now. Extended Access is a current PCN DES service and appears as a candidate for bundling at MNP level. So does general practice resilience, and so does leadership and transformation support for the neighbourhood infrastructure.
What the consultation does not say
If the additional funding comes from consolidating services that are already commissioned, then somewhere in every system there is a provider whose contract, and the money attached, is being absorbed into a bundle.
The document sets out the mechanism and the safeguards for practices, but it does not address what happens to the organisations currently delivering out-of-hours, 111, or urgent treatment when those contracts are bundled.
It's also important to recognise that NHS England says it does not think the PCN DES and the SNP Contract should co-exist in the same geography, because they would be likely to cover the same population within an MNP. But the technical detail also says that where an MNP has a PCN within its geography rather than an SNP, the MNP would be able to subcontract the delivery of enhanced primary medical services to that PCN.
Submitting a response
Nothing in this is contractual yet, and nobody is obliged to respond.
However, if you want to influence it, a coordinated, strategic response across your neighbourhood, rather than several separate submissions that partly contradict each other, would have a stronger impact.
The reason to do it together
Producing one response forces the conversation you would have to have anyway.
You find out where your practices actually stand.
You surface the different perspectives across the neighbourhood, and you work through the pros and cons of each option together rather than separately.
You end up aligned, and you know where the disagreements are before a commissioner asks you.
That is worth doing regardless of what NHS England decides, and regardless of which route your area eventually takes.
All details can be found here: https://www.england.nhs.uk/long-read/a-consultation-on-proposed-mnp-and-snp-contracting-models-technical-detail/
In a nutshell, here is what we do know
The GP Contract is not part of this. GMS, PMS and APMS continue to commission core general practice services.
There is no new national funding for these contracts.
The PCN DES remains available.
Minimum investment equivalent to the PCN DES, including ARRS, is protected under every option. What is still being written is the specification.
The options cannot be taken forward in parallel. Commissioners and PCNs would need to choose one.
An SNP Contract must be held by a legal entity, but that can be a lead practice on behalf of a consortium.
Nothing is final. A further consultation on firmer proposals follows later this year.
The consultation closes on 10 September 2026.
We hope this helps.
📅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.
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