Implementing the Neighbourhood Health Service: Commissioning and procurement

When unveiling the 10 Year health Plan earlier this month, the government made good on its promised big shift ‘from hospital to community’ by announcing a new operating model – the Neighbourhood Health Service.

The government stated that ‘This work will begin this year with the launch of the National Neighbourhood Health Implementation Programme.’ However, commissioners (integrated care boards) are already keen to understand how to commission and procure this service; and potential providers (GP federations/alliances and community trusts) are keen to understand how to prepare.

While the detail of the 10 Year Health Plan is still being digested, and further practical information and direction from the centre is expected over coming months, there are some key takeaways from the Plan that commissioners and providers can act on right away. 

How will the Neighbourhood Health Service be implemented?

• Two new primary care contracts will be the delivery mechanism for the Neighbourhood Health Service – the Single Neighbourhood Provider (SNP) contract delivering enhanced services for neighbourhoods (populations of c.50k), and the Multi-Neighbourhood Provider (MNP) contract delivering care at scale (populations of c.250k).

Who will commission SNP and MNP contracts?

• As strategic commissioners, integrated care boards (ICBs) will commission all but the most specialised clinical services, from both NHS and independent sector providers. This will include SNP and MNP contracts.

Who will provide SNP and MNP contracts?

• The Plan empowers and encourages ICBs to do what is best for their population, and does not mandate a specific type of provider for each contract. However, the Plan highlights that:
  • For SNP contracts, in many areas, the existing Primary Care Network (PCN) footprint is well set up as a springboard for this type of working. 
  • For MNP contracts, in some places this role is already being played by GP federations, with excellent results. However, ICBs will have freedom to contract with other providers for neighbourhood health services, including NHS trusts.

How will SNP and MNP contracts be procured?

• The Plan did not signal any changes to public procurement legislation. Therefore, these contracts will be commissioned in the same way as existing contracts.
• As these contracts are for (or mainly for) health care services, they will be subject to the Health Care Services (Provider Selection Regime) Regulations 2023 and awarded via either the Most Suitable Provider (MSP) process or the Competitive process. For areas that already have services similar to SNP and MNP contracts in place, modifications to existing contracts without these processes may be possible, but this will only be possible in limited circumstances, on a case-by-case basis, once the SNP/MNP specifications are known.
• The Plan envisages ICBs ‘market making’, which likely refers to:
  • The wide discretion ICBs are afforded to decide what services they want to commission and service design; and
  • The ability of ICBs to determine the application and weighting of key criteria to decide who is best placed to deliver those services and the structuring of the evaluation process.
• However, usual procurement principles apply. ICBs must focus on people’s needs and the quality and efficiency of services. Processes must be transparent, fair, and proportionate. 
• ICBs will need to navigate the complexities and indeed flexibilities of choosing, designing, managing and running these processes. Key to robust decision making will be ICBs’ ability to develop and leverage their intimate knowledge of the provider landscape and robust engagement processes with interested providers and other stakeholders.
• Providers will need to explore how best to prepare for these processes. This will include identifying, enhancing and evidencing their ability to deliver SNP and MNP contracts, and identifying (or if necessary establishing) the appropriate corporate vehicle to do so.

How about existing primary care contracts?

• For now, it appears core primary care contracts (GMS, PMS and APMS contracts) will continue to be commissioned by ICBs and provided by practices of all shapes and sizes. 
• However, while the Plan says that the traditional GP partnership model should continue where it is working well, it says GPs will be encouraged to work over larger geographies through leading new neighbourhood providers. This could see the development of more integrated, ‘at scale’ core primary care services too, where commissioners and providers desire this change.

How will contracts be managed?

• The Plan foresees MNPs coaching and stepping into individual practices struggling with performance or finances, but also confirms that ICBs as strategic commissioners can take ‘decisive’ action to decommission poor services. 
• Therefore, the full spectrum of contract management activities will be shared between commissioners and providers, and division of roles will require careful consideration and design, including for managing conflicts of interest.
• Looking further ahead, the Plan expects the highest performing NHS foundation trusts to become integrated health organisations (IHOs) holding the whole health budget, in which case the IHO would be the lead provider in the geography.

Next steps

Please keep an eye on our website and social media for more detailed analysis of the Plan and what this means for commissioners and healthcare procurement practitioners over the coming months. In the meantime, we are already working with ICBs and a range of providers to understand how to implement the Neighbourhood Health Service. Please do not hesitate to contact us to discuss your next steps.

Lucy Probert is a Legal Director and Richard Parker and Ruth Griffiths are Partners at Hill Dickinson.