Neighbourhood Health Framework: what it means for practices, partners and PCN leaders

The policy direction has been clear for some time: more care closer to home, more prevention, more joined-up working, and less reliance on fragmented pathways. What is changing now is the structure underneath it.

The Neighbourhood Health Framework set out the ambition for neighbourhood care. The newer NHS commissioning model begins to define how that ambition may actually be organised, commissioned and led. For practices, partners and PCN management, that matters because it affects not just service design, but influence, delivery roles, local planning and the shape of primary care over the next 3 years.

What is changing?

The NHS is moving from neighbourhood working as a broad policy ambition to neighbourhood working as a more formal delivery model. In plain terms, this means care is increasingly intended to be organised around defined local populations rather than around separate organisations each managing their own part of the pathway.

That is the thinking behind the shift to population-based contracting. Instead of commissioning lots of disconnected services and trying to knit them together afterwards, integrated care boards are being asked to commission around neighbourhood footprints and population outcomes.

For general practice, the practical significance is that even where the core contract remains the same, the structure around it is beginning to change. Neighbourhood delivery, service coordination, resource allocation and local influence are all moving into sharper focus.

Why this matters for practices, partners and PCN management

For most readers in general practice leadership, the main question is not whether integrated neighbourhood working is a good idea in theory. It is what this means in practice for the organisations and people expected to make it work.

The new model matters because it starts to shape:

  • who leads neighbourhood delivery
  • how services outside core general practice may be organised
  • how PCNs fit into future local structures
  • where operational influence sits
  • how funding and accountability may shift over time

In other words, this is not just a clinical integration story. It is a leadership, governance and delivery story too.

The new model explained

The proposed architecture works in layers. Each layer covers a defined population and is intended to fit inside the one above it, so that outcomes can be aligned from system level through to neighbourhood level.

Integrated Care Boards (ICBs)

ICBs remain the strategic commissioners. They agree neighbourhood footprints with partners, set commissioning plans and determine the outcomes contract holders are expected to deliver.

Integrated Health Organisations (IHOs)

IHOs operate at whole-population level. They hold a defined budget for a geography and take responsibility for resource allocation and service planning across the wider care pathway.

Multi-Neighbourhood Providers (MNPs)

MNPs sit across multiple neighbourhoods. Their role is to coordinate delivery at a larger scale, bring consistency across aligned populations and step in where neighbourhood delivery cannot be sustained at SNP level alone.

Single Neighbourhood Providers (SNPs) and GP practices

SNPs are intended to deliver neighbourhood services through Integrated Neighbourhood Teams, working alongside local GP practices whose GMS, PMS or APMS contracts remain separate.

The reason this matters is that it creates a clearer chain between strategic commissioning, neighbourhood service delivery and local accountability. It is also the mechanism through which the NHS hopes to move more care into community settings and reduce fragmentation across pathways.

Diagram showing ICB, IHO, MNP, SNP and GP practice relationships in the population-based contracting model

Figure: the contract models are intended to nest within one another so that populations and outcome measures align from ICB level to neighbourhood level.

The 3 new contract models in plain English

Single Neighbourhood Providers (SNPs)

SNPs are the neighbourhood-level delivery model. Their role is to deliver neighbourhood services through Integrated Neighbourhood Teams for a defined neighbourhood population.

This is an important distinction: the SNP model is intended to support neighbourhood services that sit outside existing GMS, PMS and APMS contracts. So while SNPs may sit very close to general practice operationally, they are not simply a rebadged practice contract.

For practice leaders, the practical question is how closely the SNP model in your area will be tied to existing PCN structures, practice relationships and local delivery capability.

Multi-Neighbourhood Providers (MNPs)

MNPs coordinate delivery across multiple neighbourhoods. They are intended to provide scale, consistency and resilience across a larger footprint than a single neighbourhood can manage on its own.

In some areas, that may mean providing shared infrastructure or coordinating consistent service models. In others, it may mean delivering services directly at scale or filling gaps where an SNP is not able or willing to do so.

For PCN and neighbourhood leaders, MNPs matter because they may become an important part of the layer above neighbourhood delivery: not replacing it, but shaping how it works and how consistently it is expected to perform.

Integrated Health Organisations (IHOs)

IHOs are the broadest and most strategic part of the model. They hold a whole-population budget for a defined geography and take responsibility for planning care and allocating resources across the pathway.

The stated purpose is to reduce fragmentation and create better incentives to invest in prevention, neighbourhood working and community-based alternatives to hospital care.

Two points stand out. First, IHO contracts can only be held by NHS organisations. Second, IHOs are expected to contract with and coordinate other providers beneath them, including MNPs and, indirectly, neighbourhood delivery.

For practices and PCNs, IHOs may feel remote at first, but they are important because they are likely to influence the funding flows, priorities and delivery architecture that sit over neighbourhood care.

Diagram showing ICB commissioning plan, IHO resource allocation, and delivery across MNPs, SNPs, GP practices and other providers

Figure: under the proposed model, the ICB sets the commissioning plan, the IHO allocates resources and designs the care model, and delivery then flows through neighbourhood and wider provider arrangements.

What stays the same?

It is just as important to be clear about what is not changing, at least not at this stage.

  • GMS, PMS and APMS remain nationally determined and commissioned locally.
  • ICBs remain strategic commissioners.
  • Providers may continue to hold multiple contracts during transition.
  • Existing contract methods may continue alongside new arrangements while the system evolves.

That means the core practice contract is not simply being absorbed into a new neighbourhood structure. The bigger change is that the commissioning and delivery environment around it is becoming more formal, more layered and more strategically important.

What this means for PCNs

PCNs remain part of the current operating model, but they are now firmly within the conversation about what neighbourhood delivery looks like next.

NHS England has said it will consult on how SNPs, MNPs, GMS and the PCN DES should work together, including how PCNs might evolve into SNPs. That makes the future role of PCNs one of the most important unresolved issues in the whole model.

For PCN management and member practices, this creates a strategic question rather than just an operational one. If neighbourhood delivery becomes more formal, will the PCN be the vehicle for that delivery, the foundation for an SNP, one part of a wider arrangement, or something gradually overtaken by a different local structure?

The answer will vary locally, but it is already clear that practices and PCNs with strong relationships, credible delivery capability and a clear neighbourhood role are likely to have more influence over what happens next.

Why the NHS is moving in this direction

The case for change rests on 3 familiar pressures.

  • fragmented pathways — multiple organisations delivering different parts of care under separate arrangements
  • misaligned incentives — one part of the system invests while another part captures the benefit
  • resource imbalance — a long-standing tendency for the system to find it easier to fund hospital activity than shift care into neighbourhood and community settings

Population-based commissioning is intended to tackle those problems by aligning outcomes, funding and delivery responsibility around the same defined populations.

What changes operationally for practices and PCNs?

The NHS documents are written at system level, but the operational implications for practice and PCN leaders are already fairly visible.

More formal neighbourhood working

Integrated working is likely to become less informal and more structured, with clearer expectations around neighbourhood delivery, partnerships and local accountability.

Greater focus on geography and footprint

Neighbourhood boundaries will matter more. Practices and PCNs will need to understand how their current footprint aligns with local plans and whether existing arrangements fit the emerging model.

More complexity around the core contract

Even where the practice contract itself stays the same, the delivery chain around it becomes more layered, with additional interfaces between practices, PCNs, SNPs, MNPs and IHOs.

More importance placed on data and population insight

The whole model depends on joined-up data, better understanding of population need, and a clearer link between activity, cost and outcomes across neighbourhoods.

Greater scrutiny of local delivery capability

Practices and PCNs that can show operational maturity, strong relationships and credible delivery are more likely to shape the model than simply be affected by it.

Earlier strategic conversations

Questions about neighbourhood leadership, local governance, future delivery roles and how funding may flow are no longer distant policy issues. They are increasingly live local planning questions.

What this does not mean

  • It does not mean practices are automatically being merged.
  • It does not mean GMS, PMS or APMS are disappearing.
  • It does not mean every area will adopt the same model at the same speed.
  • It does not mean the future role of PCNs has already been fully decided.
  • It does not mean every provider can hold an IHO contract.

What practice and PCN leaders should be doing now

Nobody needs to redesign their operating model overnight. But this is exactly the stage where early leadership work starts to matter.

  1. Brief partners and senior managers properly. Make sure the discussion is about the emerging delivery and commissioning model, not just neighbourhood care as a broad policy concept.
  2. Get clear on your neighbourhood footprint. Understand how your practice and PCN sit within local geography, place structures and likely neighbourhood boundaries.
  3. Speak to your PCN Clinical Director and local system contacts. Ask what is known locally about SNP thinking, MNP planning, ICB expectations and likely sequencing.
  4. Assess your current delivery credibility. Look honestly at relationships, governance, operational maturity, programme delivery and whether your practice or PCN could credibly lead or anchor part of a more formal neighbourhood model.
  5. Track consultation and technical guidance closely. The unresolved questions around PCNs, SNPs, MNPs and GMS are likely to matter more than broad strategy language.
  6. Watch the funding and influence signals. Even before contract structures change locally, system attention and investment may increasingly favour neighbourhood capability, prevention and population-based delivery.

Practical follow-up

Turn the framework into an action plan

Read our practical checklist for preparing your practice for neighbourhood working, then download the self-assessment tracker to score readiness, assign owners and capture next steps.

Includes checklist article, scoring workbook, summary dashboard and action tracker.

Read the checklist article Download the tracker
Preview illustration of the neighbourhood working self-assessment tracker

Key dates and next steps

Timing What happens Why it matters
Spring 2026 First wave of providers eligible to hold IHO contracts expected to be designated. Shows that the IHO model is moving from concept into live implementation.
2026/27 Developmental year for SNP, MNP and IHO contracts. Local structures, relationships and early operating models are likely to begin taking shape.
2026/27 NHS England to work with early SNPs and MNPs to develop the neighbourhood care model and test payment approaches. Early adopter areas may move faster, but all practice and PCN leaders should understand the direction of travel.
Coming months Further technical guidance and consultation on SNPs, MNPs, GMS and PCN DES, including how PCNs might evolve into SNPs. This is likely to be one of the most important watchpoints for primary care leadership.
Next 3 years ICBs expected to modernise strategic commissioning and begin implementing more outcome-based contracts, with IHO contracts intended to become the norm over time. The shift is gradual, but it is no longer theoretical.

The Practice Connect view

The real significance of this shift is not the acronyms. It is that neighbourhood care is starting to acquire a more formal delivery and commissioning structure.

For practices, partners and PCN leaders, that creates both risk and opportunity. The risk is treating this as a distant system issue until local structures are already taking shape around you. The opportunity is getting close enough to local planning to influence the model, protect practice interests and help define what credible neighbourhood delivery actually looks like.

Over the next 12 to 36 months, this is likely to become less about policy interpretation and more about practical questions of footprint, leadership, delivery capability and local negotiating position.

Need help turning this into an action plan?

Practice Connect will keep tracking the Neighbourhood Health Framework, the development of SNP, MNP and IHO models, and what future consultation means for practices, PCNs and neighbourhood delivery.

Useful follow-up topics include:

Explore more Practice Connect guidance

This article reflects NHS publications available as of March 2026 on the Neighbourhood Health Framework and population-based delivery models, including the development of SNP, MNP and IHO arrangements.

Source material: NHS England and Department of Health and Social Care publications, including the Neighbourhood Health Framework, Strategic Commissioning Framework, Model ICB Blueprint and associated population-based delivery model guidance.