The NHS 10-Year Health Plan outlines a long-term vision for care that is more integrated, community-based, and increasingly structured around neighbourhood-level working. It discusses prevention, population health, data-driven decision-making, and care delivered closer to home.
But while the direction of travel is becoming clearer, the destination – and more importantly, the route to get there – is still full of unknowns. For GP practices, the challenge isn’t just understanding the vision, but also navigating the uncertainty surrounding how it will be implemented, funded, and governed.
There are early signs that this could reshape how general practice is structured, funded, and even sustained. While not everything is finalised, there is growing concern that delaying engagement entirely could make it harder to adapt later on.
What’s Changing?
At the centre of the 10-Year Plan is the proposed Neighbourhood Health Service, which will be delivered through two new types of contracts:
- Single Neighbourhood Provider (SNP) contracts – aimed at populations of around 50,000 patients. These are likely to align closely with Primary Care Networks (PCNs).
- Multi-Neighbourhood Provider (MNP) contracts – for larger footprints of 250,000+, with broader responsibilities.
While these contracts are not expected to replace GMS/PMS arrangements immediately, they are likely to become the preferred route for delivering new services and accessing investment. This presents a dilemma for practices—particularly those not currently involved in structured collaborations—as key income streams such as ARRS, PCN DES, and enhanced services could shift into these new contracts over time.
A Difficult Balancing Act
The plan doesn’t seek to dismantle the GP partnership model entirely. In fact, there are reassurances that partnerships will continue “where they are working well.” But this comes alongside encouragement for GPs to play a greater role in neighbourhood-level delivery through new, larger-scale providers.
This puts practices in a difficult position:
- Joining a new neighbourhood contract may require a shift in structure, accountability, and financial risk.
- But remaining outside of these models might result in reduced access to funding and decision-making.
The concern for many is that the practical incentives to join a neighbourhood model may begin to outweigh the protections of staying independent. While there is still time for details to emerge, the risk is that practices who disengage now may find themselves having to adapt rapidly later, without the same degree of choice or influence.
Legal Structures: Being “Contract Ready”
One practical challenge is that some PCNs are not legally constituted in a way that allows them to hold a formal NHS contract. This is likely to become a sticking point as the SNP and MNP models evolve.
To engage meaningfully in the new landscape, some form of legal structure will probably be required – this may require incorporating the PCN. Since the introduction of PCNs we have already had discussions with some of our PCN clients to help them understand what incorporation means to them.
Incorporation brings various considerations – governance, liability, VAT, corporation tax, pensions, employment risk – and will require careful planning. There’s no one-size-fits-all solution, and many PCNs/Practices may feel unsure about how or whether to take that step. But beginning to explore the options could be a useful part of broader succession and sustainability planning.
Financial Risks and Questions That Still Need Answers
Many practices are already feeling financial pressure. The idea that funding streams like ARRS and DES may be absorbed into SNP contracts adds another layer of complexity. The unanswered question is what happens to a practice that chooses not to join – or isn’t included in – a neighbourhood provider model.
In theory, core GMS/PMS funding would remain. However, if all non-core funding were to move elsewhere, some practices may struggle to remain financially viable. This could also affect access to the workforce, estates funding, and digital transformation.
For now, practices may want to begin modelling different scenarios – particularly what their income and staffing might look like with or without access to PCN and neighbourhood funding. This isn’t about predicting the future with certainty, but about understanding the range of possibilities that may emerge.
The Role of IHOs
A further development mentioned in the Plan is the creation of Integrated Health Organisations (IHOs) – large providers, such as Trusts, that could eventually hold the entire local health budget, including GMS and community care.
Although this remains an ambition rather than a certainty, it does raise concerns about the future autonomy of general practice – particularly in areas without strong GP-led provider networks. If these new providers take on commissioning-like roles, general practice could find itself operating under subcontracting arrangements or new models of oversight.
The question isn’t just who holds the budget, but how practices can retain influence, sustainability, and professional satisfaction within whatever new structure emerges.
Geography, Scale, and the Pressure to Merge
Another practical issue is scale. Not all PCNs meet the suggested 50,000 patient threshold for SNPs, and some may face pressure to merge or realign geographically. This could be particularly challenging for:
- Single-practice PCNs
- PCNs with historical tensions or fractured working relationships
- Rural areas where population spread makes neighbourhood alignment more difficult
It’s not yet clear how rigid the population thresholds will be, or how ICBs will support local variations. But smaller PCNs may wish to start considering what collaboration with neighbours could look like – even if only on a contingency basis.
How Should Practices Respond?
This is not an easy time to make decisions. Much of the detail is still missing. There are financial, operational and clinical risks associated with both action and inaction. But there are some areas where early reflection may help:
- Structure: What legal structure (if any) do you currently have that would allow you to participate in future contracts?
- Collaboration: Are you already part of a PCN or federation with contracting capability – or would you need to create something new?
- Finance: How dependent are you on non-core income streams? Could you maintain viability if these were redirected?
- Workforce and governance: Do you understand the HR, tax and operational implications of joining a shared entity?
- Succession and influence: Are you likely to have a voice in shaping your local neighbourhood model, or would decisions be made elsewhere?
It’s entirely reasonable that many practices are feeling uncertain or even uneasy about the 10-Year Plan. There are still big gaps in the details. There are risks for the traditional model. And the speed of change may feel difficult to reconcile with already stretched teams.
General practice has consistently demonstrated its ability to adapt to change. The challenge this time may be less about immediate action and more about thoughtful preparation, so that when decisions do need to be made, they’re made from a position of strength, not surprise.
For more information, join our upcoming online webinar with BHP and Sintons LLP.
Please contact the BHP Healthcare team if you have any questions or concerns.
