NHS England is proposing a new contracting model for primary care that allows Primary Care Networks (PCNs) and GP practices to enter into single-neighbourhood provider (SNP) contracts without the need to establish new legal entities. According to an official NHS England consultation, this approach aims to streamline the delivery of integrated care by removing the administrative and legal barriers that previously forced practices to merge or create complex corporate structures to hold a single contract.
The shift focuses on moving away from the fragmented “payment by exception” and individual practice contracts toward a model that rewards outcomes at a neighbourhood level. By eliminating the requirement for new legal entities, the health service intends to encourage collaboration between practices while allowing them to maintain their existing independent legal status and ownership structures.
This proposal arrives as part of a broader effort to implement the 2023 Long Term Plan and the government’s focus on “integrated care systems” (ICS). The goal is to ensure that patients receive consistent care regardless of which specific surgery they are registered with within their local neighbourhood, shifting the focus from individual practice performance to the collective health of the local population.
Removing Legal Barriers for Single-Neighbourhood Provider Contracts
Under the proposed framework, NHS England has clarified that there will be no requirement for PCNs or practices to form new legal entities to hold single-neighbourhood provider (SNP) contracts. This is a significant departure from previous interpretations of integrated care, where the desire for a “single point of accountability” often implied the need for a single legal employer or a merged corporate body.
According to the NHS England consultation documents, the new model allows a group of practices to act as a single provider for the purposes of the contract while remaining separate legal entities. This means that GP partners can retain their individual business assets and employment contracts while collaborating on a shared budget and a set of collective clinical targets.
The removal of the legal entity requirement is designed to reduce “friction” in the transition to integrated care. In previous iterations of primary care reform, the prospect of forced mergers or the creation of cumbersome “super-practices” created significant resistance among GP partners who feared losing clinical autonomy or financial control over their individual surgeries.
The Shift Toward Population-Based Health Management
The SNP contract model is designed to move primary care toward “population health management.” Instead of funding being tied strictly to the number of patients registered at a specific site, the new contracts aim to allocate resources based on the needs of the entire neighbourhood.
This approach allows for the flexible deployment of the Additional Roles Reimbursement Fund (ARRF), which pays for pharmacists, physiotherapists, and social prescribers. Under a single-neighbourhood contract, these staff members can be deployed where they are most needed across the neighbourhood, rather than being tethered to a single practice’s patient list.
By treating the neighbourhood as a single unit, NHS England argues that care can be more effectively coordinated. For example, a patient with complex comorbidities can access a specialist clinician within their PCN regardless of whether that clinician is based at their own GP surgery or a neighboring one, without the administrative hurdle of inter-practice billing or separate contractual agreements.
Impact on Primary Care Networks (PCNs) and GP Practices
The proposal directly affects the operational structure of the thousands of PCNs across England. Currently, PCNs operate as “collaborations” rather than formal legal entities, which has sometimes limited their ability to hold large-scale contracts or employ staff directly without using a “lead” practice.
The new guidance suggests a “lead provider” or “jointly held” arrangement where the legal liability and financial responsibility are shared or managed through a designated lead, without requiring a full corporate merger. This allows practices to benefit from the economies of scale associated with a larger contract—such as better bargaining power for procurement or streamlined reporting—without the risk of losing their independent status.
Critics of previous primary care reforms have often pointed to the “administrative burden” of PCN reporting. The SNP model intends to replace multiple, overlapping reports from individual practices with a single, consolidated report for the neighbourhood, reducing the time clinicians spend on paperwork.
Next Steps for the Consultation Process
NHS England is currently seeking feedback from primary care providers, Integrated Care Boards (ICBs), and professional bodies on the specifics of these contract templates. The consultation focuses on the balance between collective accountability and individual practice autonomy.
The next confirmed checkpoint in this process is the analysis of the consultation responses, which will inform the final design of the SNP contracts before they are rolled out for implementation. Official updates on the timeline for the transition to these new contracts will be published via the NHS England primary care communications channel.
Readers interested in the ongoing evolution of the NHS are encouraged to share this article and provide comments on how integrated care models might affect patient access in their local areas.
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