September saw the end of the first phase of the consultation process on the NHS England consultation on proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models to support neighbourhood health services.
This is the first phase of the consultation process with a second consultation expected later this year. Our response reflects the core principles around the need to protect and improve care for patients and strengthen general practice. Whilst it is based on what can reasonably be said at this stage, the consultation contains limited detail and we will be updating our position as the proposals develop.
Londonwide LMCs supports the ambition behind the proposed neighbourhood arrangements: to make care simpler and more joined up for patients, improve health and outcomes, organise services around population need, enable organisations to work together more effectively, and support strong and sustainable general practice and community services.
We recognise that the current contractual and commissioning landscape can create genuine barriers to achieving these ambitions. There may therefore be a strong case for contractual change.
However, we believe the sequence of design matters. The starting point should be patient and population need, followed by an understanding of what creates value in care and what good care looks like. We should then understand the problems preventing that care, the evidence and assumptions behind proposed solutions, the constraints and trade-offs, and what needs to change. Only then should we determine the appropriate organisational scale, commissioning model and contractual mechanism.
We therefore support change where there is a clear evidence-based case for it. However, contractual change must strengthen, rather than undermine, authentic general practice and the independent contractor model. Core general practice and additional neighbourhood services are different functions and should not be conflated. General practice should be enabled to develop and deliver additional services at scale where this improves care, but only where those services are properly resourced.
Our responses also recognise that this is an early consultation and that significant detail remains unknown. We therefore distinguish between what can reasonably be supported now and what requires further evidence or clarification.