Primary care leaders have earned their cynicism. After decades of shifting goalposts, reform fatigue isn’t just corporate-speak, it’s a professional survival mechanism!
The new Fit for the Future document released on 17 March and the subsequent Network Contract DES, show that this isn’t just another pilot project or superficial rebrand, it is the blueprint for a permanent structural evolution.
The PCN DES provides hints of the groundwork needed for future while the Fit For Purpose guidance serves as the literal architecture for the next decade where the neighbourhood becomes the primary unit of delivery.
For those at the helm of Primary Care Networks (PCNs), it raises an inescapable question: Is the PCN reaching its natural conclusion to make way for a more integrated, singular provider entity?
Are PCNs in a Transition State?
The PCN is not being abolished, but it is being fundamentally re-coded. Fit for the Future provides a clear consultation signal that Primary Care Networks are expected to evolve into Single Neighbourhood Providers (SNPs). This is a landmark moment because, for the first time, the PCN Directed Enhanced Service (DES) is being integrated directly into the neighbourhood contract conversation.
Fit for the Future states that NHS England will consult on how MNPs, SNPs, GMS and the PCN DES will work together, including how PCNs might evolve into SNPs.
This shift from “Network” to “Provider” represents a significant leap in governance. While networks emphasise collaboration between separate entities, the SNP model moves toward a formal provider structure capable of holding integrated contracts. It addresses the “needless fragmentation” mentioned in the blueprint that has historically hindered community-based care.
What is a Single Neighbourhood Provider?
In simple terms, an SNP is a formal provider entity responsible for the health outcomes of a specific “neighbourhood” (typically a population of 30,000 to 50,000). While PCNs were designed as a collaboration of independent practices, the SNP is envisioned as a singular provider that holds a unified contract.
This contract won’t just cover core GP services; it is designed to integrate out-of-hospital care, including community pharmacy, mental health, and community diagnostics—into one accountable team. Essentially, the SNP is the evolution of the PCN from a voluntary network into a permanent, professionalised provider organisation.
What is an Integrated Health Organisation (IHO)?
The Integrated Health Organisation (IHO) is a new class of NHS Super-Provider under the Neighbourhood Model. These entities are designed to hold a whole population health budget for a defined geography, wielding the power to allocate resources across the entire care pathway. Initially, IHO contracts are restricted to high-performing Advanced Foundation Trusts, with the first wave of designations occurring in Spring 2026.
The delivery hierarchy is now explicitly nested to align objectives from the system level down to the individual patient:
- ICB (Integrated Care Board): Strategic commissioner setting outcomes.
- IHO (Integrated Health Organisation): Budget holder and resource allocator.
- MNP (Multi-Neighbourhood Provider): Coordinator across multiple footprints.
- SNP (Single Neighbourhood Provider): Delivery vehicle via Integrated Neighbourhood Teams (INTs).
- GP Practices: The registered list foundation.
Notably, the IHO’s reach extends beyond traditional medical services to include the management of pharmacy, optometry, and dentistry. This consolidation is a strategic move to align incentives across the entire delivery chain. Their core responsibilities include strategic service planning and the specific mandate to undo fragmentation that traps funding in acute silos.
How are Management Contracts Changing?
Fit For The Future confirms that IHO contract holders will take on local contract management responsibility for GMS, PMS, and APMS general practice contracts. This means the entity you answer to (i.e. the local authority managing your contract) is shifting from an ICB to the IHO super-provider.
SNPs are positioned as an addition to, rather than a replacement for, core general practice. This structure ensures that while practice identity is protected, the “neighbourhood” is the primary unit through which any new funding or service expansion flows.
2026/27 is a Developmental Year
Forget the rumors of a delay until 2027/28, the architecture is being built right now. The 2026/27 cycle has been formally designated as a “developmental year,” moving the narrative from stagnation to active construction. Spring 2026 marks the first wave of IHO designations and the launch of pilot work for the first wave of SNPs and MNPs.
To ensure this isn’t just a paper exercise, the Strategic Commissioning Development Programme is providing the heavy lifting. This includes specialist analytics and actuarial support to help local teams baseline risk and cost. Systems are expected to finalise neighbourhood footprints immediately and establish Integrated Neighbourhood Teams for high-priority cohorts. This moves the agenda from “wait and see” to immediate tactical planning.
What Can Your PCN Do to Prepare?
If 2026/27 is a “readiness test” for this shift, here are the three strategic pillars you need to build today.
| Action | Immediate Steps (Pre-2027) |
| Formalise Structure | Review your current lead practice model. Should you move toward a single legal entity, such as a Super-Practice, GP Federation arm, or Joint Venture, capable of holding clinical risk? |
| Centralise Management | Having a scalable model that utilises resources across the neighbourhood (and not simply devolving roles down the practice) will be crucial for success. Create the robust and centralised PCN management now. Invest in a structure that manages INTs and monitors requirements like the “60 minutes per 1,000 patients” access standard in real-time. |
| Skill-Mapping | Stop hiring for individual practices. Map skills across the entire PCN to identify gaps and priorities before the SNP contracts arrive. Start thinking about how yourARRS-funded pharmacist can add value at a network level, not just how they can fill a role at a particular practice. |
Don’t Waste the Transition Year
While the final details of the Single Neighbourhood Provider contracts are still being refined at the national level, the structural requirements are already visible.
PCNs that spend this year professionalising their management and hardening their governance will be the ones that lead the transition. Those that treat 2026/27 as “business as usual” risk being “done to” when the more formal neighbourhood contracts arrive.
The question for PCN leaders is no longer if you will become a neighbourhood provider, but how ready you will be when the contract arrives.
Bridging the Gap
At Medacy, we already operate on the Neighbourhood principles the NHS is now moving toward.
- Standardised Excellence: We use a centralised management model to ensure pharmacists work to joint standards of care, whether they are on-site or remote.
- Strategic Deployment: Rather than parachuting a pharmacist into a single gap, we help you build a Neighbourhood Medicines Optimisation Team.
- Data-Driven Care: We align with the SNP vision by deploying resources where data shows the greatest need, such as targeting high-risk Structured Medication Reviews (SMRs) across your entire 50k population.
- Operational Relief: We help bridge the gap between traditional practice models and the integrated future, ensuring your pharmacy team is a strategic, mobile asset rather than a static one.
To learn more about how we are helping PCNs leverage pharmacist support across their network and creating a model fit for the future, get in touch today.
