What does the Neighbourhood Health Framework mean for independent providers?

IHPN’s Head of Policy (Primary, Community, and Diagnostic Care) Joshua Edwards analyses the recently released neighbourhood health framework and what it’s potential impact would be on the independent sector.

This week’s publication of the Neighbourhood Health Framework has been long awaited by a primary and community sector keen to understand how the ambitions set out in the Ten Year Health Plan for England around shifting care into the community and incentivising the creation of a neighbourhood health service were to be made a reality.

However, the framework may pose more questions than it answers. For those looking for central prescription of what should be included in a neighbourhood or integrated neighbourhood team, licence is instead being given to Integrated Care Boards and Health and Well-Being Boards to decide what services should look like locally, focusing on outcomes rather than format. Likewise, further detail on new contractual arrangements such as those for single and multi neighbourhood health providers are to be subject to further consultation, extending uncertainty.

Instead, the Framework sets out some key metrics by which neighbourhood working will be judged. Some of these, such as improving health outcomes for particular cohorts or improving GP access and ensuring same-day appointments for those in need of urgent attention, have already been included in the recent GP contract and Medium Term Framework from last autumn.

Others, such as improved experience of planned care and better urgent and emergency care performance, are as dependent on acute providers as they are primary and community providers. Worryingly, much of the weight of this aim seems as it will be carried by an increased use of single points of access (SPOAs). For this to work, significant additional guidance will be required. SPOAs can be transformative – MSK services around the country benefit from the model – but there is a significant risk that mass introduction of the model will simply recreate often counterproductive Referral Management Centres.

Far from providing clarity regarding what neighbourhoods and integrated neighbourhood teams might look like in practice, then, NHS England have set some broad expectations and asked local systems to fill in the details, favouring permission over prescription. However, there are some areas where independent providers can see greater direction. In particular:

• Single and multi-neighbourhood providers will be expected to provide services out of scope of the existing GMS and APMS contracts. Many at-scale providers are already delivering care over and above contracted activity and making use of population health approaches to support the wellbeing of their communities, creating opportunity for primary and community providers to take on some of these contracts once consultation has concluded.

• Reform of out-of-hours services, including the setting of common minimum expectations and how they relate to 111 services, will likewise impact IS providers delivering contracted services in this part of the primary care landscape.

• The Framework sets out a forthcoming review of direct access to diagnostics services by GPs, including the mapping of existing diagnostic and community diagnostic centre capacity. Recent market engagement by the NHS has trailed the need for independent sector providers to deliver around 2m extra scans in the next three years, and it’s positive to see this reinforced in the framework’s ambitions.

• Likewise, the shift to community and development of neighbourhood health centres can only be delivered through partnership with private-sector investment, which will be expected to provide 80% of the expected funding. Alignment with neighbourhood mental health centres and CDCs also gives greater clarity on how these programmes sit together, rather than being produced in parallel.