On 3 July 2025, the UK government published the NHS Fit for the Future 10-Year Health Plan. The plan offers a bold vision for a new healthcare system, identifying three primary objectives which are intended to address some of the NHS’s deep rooted structural failings around service delivery, access, staff retention and prevention:
The central aim of the plan is to shift services from hospital to community settings to ease the pressure on hospitals and make primary care more accessible at community level. In order to achieve this, the government will introduce:
This article provides an overview of the Neighbourhood Health Service and the neighbourhood contracts, and explores the impact on general practice and primary care networks (PCNs).
The Fit for the Future plan introduces two new contracts for neighbourhood services - a 'single neighbourhood' contract and a 'multi-neighbourhood' contract:
The government expects general practices and PCNs to adopt the single neighbourhood provider contract. The aim is to deliver multi-disciplinary services across one neighbourhood area which are not currently being performed by traditional PCNs.
The multi-neighbourhood provider is larger, more ambitious and will operate a range of functions currently provided by integrated care boards as well as large scale services for example running failing GP practices.
The plan does not refer to core general medical services and personal medical services contracts. Some have commented that this indicates the government’s desire for the existing model to continue. Indeed, the government has confirmed that the new single neighbourhood contract is intended to act as an ‘alternative’ to traditional general medical services and personal medical services contracts.
The overall message appears to be that well managed PCNs operating effectively will be able to continue to rely on existing core contracts but PCNs which actively want to change will be able to do so, while failing PCNs will be encouraged to merge with (or be taken over by) new single neighbourhood providers or multi neighbourhood providers.
PCNs currently delivering traditional general medical services will not be able to simply 'rebrand' themselves as a single neighbourhood provider overnight in order to adopt the new form of contract without bringing in the necessary primary and secondary healthcare consultants, tertiary care services providers and other healthcare professionals in order to operate at the multi-disciplinary level envisaged under the single neighbourhood provider contract, even if these practices are operating effectively. In many instances PCNs may need to merge and/or redesign themselves in order to maximise their delivery potential and capabilities envisaged under the single neighbourhood provider model.
In the long term, the plan makes it clear that GPs will be encouraged to work at neighbourhood level and should take a leadership role within new neighbourhood providers. Wes Streeting has said: ‘What we are doing as a neighbourhood health model is inviting GPs to step up and lead a new way of delivering neighbourhood health in a way that I think lots of GPs will be up for including GP partnerships, and those pioneers will show us the way.’ The question of what may happen to practices which choose not to join a neighbourhood provider is not yet clear.
Multi-neighbourhood providers will operate administrative functions which currently sit with integrated care boards, such as digitalisation, back-office functions, data analytics, quality improvement functions and developing estate strategy. Federations and NHS foundation trusts are expected to take on these functions given they are already operating at scale. The multi-neighbourhood provider model may not be appropriate for general practice.
Given their size, the multi-neighbourhood providers are likely to support existing practices and PCNs and will sub-contract services across their neighbourhoods, including with single neighbourhood providers. Importantly multi-neighbourhood providers will be able to offer smaller GP practices and PCNs better infrastructure and other large scale functions which may currently be lacking.
The government has indicated that existing PCN funding will remain either through existing arrangements or through the new contract model however further details of funding have been provided. This leaves unanswered questions such as whether the National Health Service (General Medical Services Premises Costs) Directions 2024 will apply to the new contracts and to what extent the new contracts will impact on notional rent reimbursement. The government may introduce a new set of directions to align with the plan, however no proposals or plans have been put forward. Funding proposals will need to be monitored once further details of the plan emerge.
As part of the Fit for the Future plan, the government sets out a vision for the creation of new Neighbourhood Health Centres (NHC) to help ease the pressure on hospitals and transform access to healthcare within communities.
NHC’s are new health centres which will be situated in local communities. They are framed as a 'one stop shop' for care and a place where a multi-disciplinary team of integrated professionals of GPs, outpatient services, nurses, pharmacists, dental, community, social and voluntary sector service workers will operate under one roof. They will be open 12 hours a day, six days a week and will provide access to coordinated services locally including care which has been traditionally hospital based such as diagnostics, post-operative care and rehabilitation.
NHC’s are intended to be modern, multipurpose buildings capable of allowing patients to access a broad range of services without the need to visit hospital and A&E. They will be a mixture of refurbishments, redevelopments and new builds.
The plan indicates there will be one NHC in every community. The plan does not define a 'community' or set out an exact number of targeted NHC’s, however ministers have promised 50 NHCs by the end of the current parliament by 2029 and between 250 to 300 by 2035. This would equate to approximately one NHC per 250,000 patients, which indicates NHC’s will operate at the 'multi-neighbourhood provider' level as opposed to the single neighbourhood provider level. This is likely to be driven by financial considerations and budget.
The overall budget for NHCs has been estimated at £3 billion. Each individual NHC is expected to cost between £2 million and £20 million, depending on scale and services provided and if the NHC is an upgrade, redevelopment or a new build. It's not clear where funding for NHCs will come from. The government has indicated an intention to draw on private sector funding and is exploring the use of public private partnerships where value for money for taxpayers is secured. It's understood that a final decision on the approach on funding will be taken by the 2025 autumn budget. This is certainly something to watch.
The plan does not refer to traditional GP practices which begs further questions. Will GP practices be replaced by or become integrated with new NHCs? In its response to the NHS 10 year plan, the Doctors Association UK commented: 'The problem with the 10-year plan is that it focuses on neighbourhood health centres without acknowledging there are already more than 6,000 neighbourhood health centres in the community called GP practices.'
While details are not yet known, it's likely that GP practices looking to integrate into new NHCs will need to lease space within the buildings. Clear lease terms will need to be drawn up which are fit for purpose and work for both parties. Particular focus will no doubt be on building costs and anticipated service charge to ensure building costs are clearly understood and identified prior to occupation.
Further, where GPs may be simultaneously entering into a new neighbourhood contract, the contract term will need to align with the proposed length of the lease and a balance will need to be struck between the needs of GPs and ensuring the security of rental income for landlords in this regard. Surveyors and solicitors will need to be involved in this process.
The plan does not refer to existing funding schemes for GPs such as grant funding for premises improvements available under the NHS Premises costs Direction 2024. On 6 May 2025, the government published the Primary Care Utilisation and Modernisation Fund 2025 to 2026, which provides funding for investment into existing surgeries to enhance the use of existing infrastructure, create additional capacity for GPs and enable additional patient appointments. GPs will understandably want comfort that the investment into NHCs will not divert funding away from existing and other proposed funding schemes.
It's clear that PCNs will continue to provide services where they are currently operating successfully.
A foreseeable and more immediate risk may be for failing PCNs and practices which are either not currently operating within a PCN or are underperforming who discover that their neighbourhood services are picked up by other better functioning entities holding a single-neighbourhood contract or a multi-neighbourhood contract. It's not clear if the government would protect these failing PCNs or how they would be incorporated into these better functioning providers.
In the long term, PCNs may no longer be required if the new neighbourhood contract model is widely adopted. This assumes a genuine shift to the single neighbourhood provider model does take place over the next few years as further details of the Fit for the Future plan emerge. PCNs and GPs will need to consider the new neighbourhood contract carefully once published to decide how to approach the new model. Collaboration and integration with other care providers may be necessary to adopt the new neighbourhood contract.
What is clear is that general practice will be expected to play an active role in the provision of care to the neighbourhood over the next 10 years. The role and focus or general practice is set to change as part of the large scale shift in healthcare into the community.
If you have any queries please contact Ben Tarrant or Jessica Hedges.
