England's 10-Year Health Plan: Neighbourhood services, AI and health equity

The long awaited 10-year health plan for England landed yesterday, all 160 pages of it!

As already reported, it sets out a radical transformation of the NHS with the following three key goals:

1. Increased use of AI and digital
2. Services moving out of hospitals and intoneighbourhoods
3. Reducing the health gap and creating a healthier generation

For GP practices the plans build on primary care networks and integrated care.

Two new contracts will be introduced from 2026 to work alongside GP practices working under the traditional partnership model and current General Medical Services (GMS) contract. The contract will encourage GPs to work over larger geographies, with a neighbourhood health centre in every community. 

Single neighbourhood contract

This will build on primary care networks, having a similar footprint of around 50,000 patients. It will be most appropriate where there are similar needs of patients within a defined local area.

Multi-neighbourhood provider contract

These contracts will cover a much larger population of, say, 250,000 and where services require coordination across multiple neighbourhoods. This can include GP practices working under the traditional model as noted above. 

The services are aimed to be fully integrated with traditional hospital-centric services being provided in the community.

The Integrated Care Board (ICB) will have the choice of a wider range of providers for these contracts. Specifically, NHS trusts are mentioned and federations. Many well-established federations are already delivering on some of the aspects of the health plan and support practices that require improvement.

How will this be funded

This is one of the big questions along with delivery of such transformational change and appropriate premises being available. Premises are already an issue for GP practices and since the introduction of the Additional Roles Reimbursement Scheme (ARRS), there are simply not enough rooms to utilise ARRS roles fully.

Without new funding it is difficult to see how this can all be achieved although there are some potential clues in the plan:

• A trial of financial incentives where care is outstanding and holding back full payment where care has fallen below expectations.
• Increased power for the Care Quality Commission (CQC) to end GP contracts and so presumably move patients to a provider of one of the new contracts.
• A shift of funding from hospitals to neighbourhoods, and the new contracts.
• The use of AI and digital and productivity savings.
• Proactive healthcare , reducing demand and  cost to the NHS.
• A review of the Carr-Hill formula which “weights” patients for the basis on how GP practices are paid. The Carr-Hill formula was introduced as part of the GMS contract changes in 2004 and is based on historical data. It has already been reviewed at least twice but of course any changes would see “winners” and “losers” in terms of practice funding and therefore put in the “too difficult” pile. We know that the Carr-Hill formula doesn't work particularly well for certain patient demographics and areas of deprivation. The plan is clear on its ambitions to reduce health inequalities across the country and any review could result in a shift of funding.
• The government hopes that the private sector will step in with respect to estates and establishing neighbourhood health centres in every community, starting with the most deprived areas. The neighbourhood health centres will be open at least 12 hours a day and six days a week.
• Greater autonomy given to providers to free up costs.

Although the document talks, quite rightly, about dentistry, we must remember that their contract is quite different from GPs, who are prohibited from selling goodwill from their NHS patient list. The patient power payments referred to in the plan could mean that high performing providers see a monetary benefit from improved and proactive care. 

In conclusion, of course, there are lots of great ideas in the 10-year health plan. However, there is still a lot of uncertainty for GP practices on what this could mean for how they are funded, the risks and rewards of moving to a new contract and what business model would be most appropriate.

You can read the summary document on the Government website here.

Need help?

If you’d like to talk through any of the information in this blog and how it might affect you, we’re here to help. Get in touch with your usual Larking Gowen contact or email enquiry@larking-gowen.co.uk

Lizzy Lloyd