SNPs are devised as a new contractual model, which will deliver primary care and general practice at scale but within relatively small defined areas. They are expected to:

• deliver services via INTs (Integrated Neighbourhood Teams) within a defined, single neighbourhood covering a population of around 50,000.
• enable primary care providers to take on new neighbourhood services not currently covered by or contracted for through existing general practice contracts
• work with practices within the defined neighbourhood area to ensure they can deliver care to the registered patient lists of the local population
  • NHS England intends to consult on both how the collaboration required within SNPs could work, and how PCNs (Primary Care Networks) might evolve into SNPs. 

Like SNPs, MNPs are intended to serve as a new model for delivering primary care and general practice at scale, but are set to cover much larger areas and, crucially, are likely to be operated by NHS trusts.

They are expected to:

• cover populations of around 250,000 or more and to coordinate the delivery of services across multiple neighbourhoods
• design and coordinate neighbourhood health services within their footprint, which could include directly providing services where needed and agreed locally, for example, where the service might cover more than one neighbourhood
• work with GP practices and SNPs to deliver care to their area’s registered population list – the nature of these relationships will also be subject to consultation in the near future.

NHCs are a revival of previous attempts at delivering primary care and other services in co-located ‘one-stop’ centres and are intended to sit within SNPs or MNPs. NHCs are expected to:

• be in place in 250 sites by 2035, with 120 of those in operation by 2030 – a first wave is intended to come into operation in 2026/27 and be focused on areas of high deprivation
• serve as the ‘place to go’ for most health and wider needs in every community
• bring together GP services and a mix of community, local authority, civil society, and VCSE (Voluntary, Community and Social Enterprise) services, to enable staff to join-up patient care
• be housed in a mixture of repurposed existing estate and new builds - the first wave of NHCs is set to be largely based in pre-existing premises
• rely heavily on public-private partnerships (a form of PFI (private finance initiative)) for their construction, with only 20% of new builds to be funded via public capital investment
• be aligned with NHMCs (Neighbourhood Mental Health Centres) and CDCs (Community Diagnostic Centres)
• be located where ICBs determine them to be most effective. 

IHOs are the latest attempt at delivering vertical integration within the NHS in England and are intended to sit above, and potentially hold contracts for, MNPs and SNPs. Broadly, IHOs are expected to:

• see an NHS trust – only NHS organisations will be eligible to hold an IHO contract – hold a whole population health budget for a geographically defined population, underpinned by a contract commissioned by an ICB
• be run by high-performing AFTs (Advanced Foundation Trusts) – i.e. those NHS trusts considered to be the best performing – which could include community, mental health, and acute NHS trusts
• allocate resources, plan services, and hold responsibility for meeting the needs of the population within their footprint
• work with and contract other providers, including MNPs, in order to deliver services
• develop a decision-making infrastructure that enables a shift of care and resources away from hospitals and into community services, with an emphasis on cost effectiveness
• be coterminous with one or more MNPs, to align their planning and care delivery
• work with local partners and communities to incorporate local insight and ensure patient-centred design of governance arrangements and planning – primary care clinical leadership is explicitly cited as a vital source of this
• pending future work from DHSC, be enabled to work with mature neighbourhood providers to develop a jointly led IHO incorporating alliances, joint ventures, and the involvement of general practice
• will, subject to an ICB delegating their authority, commission all primary care contract types (including GP, dental, community pharmaceutical, and general ophthalmic services) in line with national contracts. NHS England will be consulting on how MNPs, SNPs, GMS (General Medical Services), and the PCN DES (Direct Enhanced Service) will work together, as well as how primary care networks may evolve into SNPs.
• incorporate strong clinical leadership, particularly from GPs
• be data-led, with a strong analytical approach that informs proactive care
• involve close collaboration between ICBs, local authorities, and providers
• be subject to nationally set minimum requirements for their governance, leadership, and financial discipline.

The BMA remains clear that the prospect of secondary-run general practice is an enormous risk and would pose an existential threat to the partnership model of general practice, as well as to the vital continuity of care and value for money it provides. Likewise, the BMA is deeply sceptical of the capacity for secondary care organisations to effectively lead the organisation of primary care and general practice services they do not deliver or fully understand. On this basis, the Association remains strongly opposed to the development of IHOs and to the MNP model. 

The BMA has also been consistently and strongly opposed to vertical integration within the NHS, which extends to IHOs as the latest attempt at this approach. However, while the Association remains opposed to IHOs, the clear commitment for them to be run exclusively by NHS organisations does alleviate prior concerns about them being vehicles for further privatisation of the NHS.  

The lack of clear, defined clinical leadership roles within the framework is a serious point of concern. The BMA remains clear that doctors must play a central role in the leadership and decision-making structures of any NHS model, in order to ensure those organisations are informed by the experts that understand the services they deliver and the patients they serve. In respect of neighbourhood working, it is especially important that GPs and properly qualified and regulated public health specialists have key roles in the development and leadership of any structures. 

The framework fails to fully address or clarify the future of important elements of the existing structure of general practice, thereby creating considerable uncertainty for many GPs, including those currently leading PCNs and GP federations. This only adds to wider concerns regarding the future of general practice and, as above, the partnership model in particular. 

Despite this, the prospect of PCNs evolving into SNPs could, providing essential safeguards are secured, provide a more attractive alternative to the MNP model. Depending on its terms, this approach may also help to ensure neighbourhoods are GP-led, as the BMA has called for. Therefore, the BMA will be monitoring this proposal closely and will respond comprehensively to the promised consultation when it launches. 

Although the prospect of local variation in neighbourhood structures and operating models is not inherently problematic, the prospect for so many different approaches across England could present significant challenges, particularly given ongoing challenges posed by ICB restructuring and unclear leadership at a local level. Without effective local commissioning of neighbourhood models, the proposed permissive approach could lead to unwarranted variation and post-code lotteries for patients, rather than the desired localised services. This further emphasises the need for local GPs to lead the development and operation of neighbourhood services, using their expert knowledge of local populations and their care needs. 

The emphasis on national targets within the framework – while in part understandable given the focus on local development of objectives – may risk entrenching the view that neighbourhood working is seen as a means of supporting hospitals to meet secondary care targets, rather than ensuring the delivery of high quality primary care services. Clear goals on prevention and community care are needed to help to address this and to show that the proposed shift from hospital to community is genuinely about changing the way the NHS works.

The BMA’s submission to the 10 Year Health Plan consultation stressed the importance of ‘double-running’ the funding of acute services and investment into the development of community services, to ensure that capacity within the community can be sufficiently enhanced to safely take on care transferred from hospitals. However, the framework is clear that the funding intended to support the development of neighbourhood services will be redirected from secondary care. This decision risks undermining the funding of hospitals that face enormous pressure and an ongoing corridor care crisis, while making investment into neighbourhoods contingent on the immediate transfer of workload before capacity has been built - it should be urgently reconsidered. 

Additionally, redirecting funding away from hospitals poses an equally severe risk to locally employed doctors, who do not have the same safeguards around pay as their colleagues on nationally negotiated contracts, and are therefore more vulnerable to exploitation should their place of work or terms and conditions be altered. 

Investment into neighbourhood services should also be focused on properly funding the GP contract, to ensure that the family doctor can be restored and that practices are enabled to deliver the highest quality services. The value for money delivered by the partnership model is essential to the NHS and would ensure that this investment is used highly effectively. 

A wider possible implication of this approach is for even more patients and elective care to be driven towards to the private sector, as it is a real possible that neither underfunded secondary care services or underprepared community services will be able to cope with demand. This could, in turn, increase costs for the NHS or for patients themselves, if they feel it is necessary to pay out of pocket for care to avoid waiting lists. 

The BMA has opposed the use of PFI or similar tools for many years, given its excessive costs to the public purse and the wider problems this funding model has caused across the NHS, for example, evidence from IPPR shows that PFI hospitals in England have been left with a staggering bill worth £80 billion for just £13 billion worth of investment.

The Association has, therefore, argued that investment into neighbourhood estates must come from public capital, including in written evidence to a House of Commons Health and Social Care Select Committee inquiry into neighbourhood healthcare estates. 

More widely, the BMA agrees with the conclusion that many GP premises are outdated and in poor condition, as is much of the NHS estate as a whole, due to long-term underfunding. The BMA’s 2025 GP premises survey emphasised these issues while calling for urgent funding, capacity expansion, and services charge reform to address them. It is crucial that any further development of neighbourhood estates is done in a way which enhances and best utilises existing GP practices and premises, while helping to overcome the significant challenges outlined above.

As the framework makes clear, the implications of the move to neighbourhood services will impact all doctors in all branches of practice, changing how, where, and even when they work. On this basis, it is essential that all doctors are actively engaging with these reforms, including with LNCs and LMCs.

The BMA is continuing to engage significantly with the development of the 10 Year Workforce Plan. This includes the submission of the BMA’s priorities to DHSC and NHS England and ongoing engagement with senior stakeholders. The BMA’s unemployment and doctor substitution steering groups are playing a leading role in this work. 

The proposed neighbourhood structures could also mean that many of the doctors working within NHCs, MNPs, SNPs, or IHOs more generally, may be directly employed by the given provider organisation. Any doctor in this scenario should be employed on appropriate terms and conditions, in line with BMA standard contracts. This is particularly relevant for sessional GPs, who are likely to be a major part of the neighbourhood health service workforce, and we believe should only be employed on at least the terms of the BMA salaried model GP contract.  

Regarding the potential transfer of doctors and NHS staff within the system, including from hospitals to neighbourhoods, we remain clear that any such moves must be made voluntarily and with agreement of staff trade unions.  

The framework also assumes that workforce flexibility will be delivered seamlessly, without providing detail on how this will be meaningfully achieved, or how sufficient staffing, transitions, or protection of professional conditions will be achieved. The expectation that doctors will move seamlessly across settings risks ignoring the realities of clinical practice and, if not managed correctly, could negatively impact workforce morale, with the potential to push doctors and other staff out of the NHS and into the independent sector, which has its own serious problems and structural flaws.