The NHS neighbourhood health model has its first local variation of the PCN DES Kent and Medway, while the national framework meant to standardise it is still under construction.
For pharmaceutical and medtech companies tracking where NHS commissioning is heading, Kent and Medway shows what a working neighbourhood contract looks like well before the national framework is fully settled.
Kent and Medway is one of the first places the NHS neighbourhood health model has translated into money on the table rather than a framework document. Its Integrated Care Board (ICB) has signed a local variation to the PCN Directed Enhanced Service worth £10 million a year, targeted at the 5% of the local population who generate around 30% of hospital admissions: care home residents, people receiving palliative care and the severely frail housebound. Announced on 4 June 2026, after NHS England opened up the power to agree such variations earlier in the year, the ICB describes the contract as the first use nationally of the new power to vary the PCN DES at a local level.
NHS England's own Neighbourhood Health Framework, published in March 2026, sets out a longer and route to the same destination. It proposes three new contract types: Integrated Health Organisations, Single Neighbourhood Providers and Multi-Neighbourhood Providers, for organising primary, community and social care together, and asks every ICB to start building towards them this year.
None of those contracts has an agreed payment model yet, and the BMA has some concerns with the version on the table.
The contract runs through the existing PCN DES rather than a new legal vehicle, which is what allowed it to move quickly. Kent and Medway's practices and primary care networks now receive funding for a defined set of proactive interventions: advance care planning conversations, comprehensive geriatric assessments and structured medication reviews, delivered to patients before they reach crisis point.
The scale of the target population is what makes the case for the model. Kent and Medway ICB has confirmed the funding as a minimum floor for what follows.
Adam Doyle, chief executive of NHS Kent and Medway, put the reasoning behind moving first this way:
“As ICBs take on a stronger strategic commissioning role, we think we should be brave and start that process where we know it can make the most difference...”
Dr Gaurav Gupta, chair of Kent Local Medical Committee, welcomed the GP-led design of the contract:
“This single neighbourhood model will allow practices and primary care networks to build upon the good work they are already doing…”
Other areas are also moving ahead of the national framework. In Warwickshire, three GP providers (Primary Care Warwickshire, Rugby Health and South Warwickshire GP Federation) set up Warwickshire IPC in July 2026 to lead integrated neighbourhood teams covering around one million patients across 119 practices and 20 primary care networks. It delivers work commissioned through the Warwickshire-wide Health and Care Programme, which South Warwickshire University NHS Foundation Trust leads, under a memorandum of understanding with the Trust. Both areas focus proactive care on similar patients, including people living with frailty and those approaching the end of life. Kent and Medway reaches them through a variation to the GP contract, and Warwickshire through a Trust-led programme that commissions GP-led delivery.
NHS England's Neighbourhood Health Framework sets a national target of 27 neighbourhood health centres by 2027, rising to 120 by 2030 and 250 by 2035, open at least 12 hours a day, six days a week. Getting there depends on three contract types the framework introduces alongside the centres themselves.
Integrated Health Organisations (IHOs) hold a whole-population health budget for a defined geography and can only be awarded to NHS bodies, though NHS England is exploring how mature independent providers might join through alliances or joint ventures. Single Neighbourhood Providers (SNPs) run integrated neighbourhood teams for around 50,000 people and could evolve from existing GP contracts. Multi-Neighbourhood Providers (MNPs) coordinate delivery across 250,000 or more, and the framework is markedly less prescriptive about who can hold one, opening a route for larger independent and third-sector organisations.
For 2026/27, ICBs have several key steps to complete: agreeing neighbourhood footprints, confirming how they will use pooled Better Care Fund (BCF) money, and building towards local Neighbourhood Health Plans from 2027/28. ICBs are expected to have begun using some outcome-based contracts within three years. None of the three contract types has a finished payment mechanism, and the consultations that will produce one are expected to run through 2026/27.
The BMA has concerns, not about the Kent and Medway contract but about the national IHO and MNP models, where an NHS Trust could hold a contract that includes general practice. It has said it is sceptical that secondary care organisations can effectively run primary care and describes the IHO and MNP model as a potential threat to general practice's partnership structure. Its preferred version keeps GPs in clinical leadership of any neighbourhood arrangement, built on existing partnership contracts rather than a new corporate layer.
Money is the second objection. The BMA reads the framework as funding neighbourhood services mainly by redirecting resources already committed elsewhere, which the BMA argues risks the hospital budgets those resources currently support. Its alternative is double-running funding: paying for community capacity to be built up before workload transfers out of acute trusts, rather than assuming the transfer and the capacity arrive together.
The third is how new buildings get paid for. NHS England's centres are funded through a mix of public capital and private finance, and the BMA wants public capital only, citing the £80 billion bill England's PFI hospitals face for £13 billion of original investment as the reason to avoid repeating that model for primary care infrastructure.
For pharmaceutical and medtech companies, the framework's next steps and its 2027/28 local plans are the near-term calendar to track, not the 2030 and 2035 centre-building targets. Commissioning decisions taken this year, particularly around Better Care Fund pooling and which cohorts each ICB prioritises, will shape which conditions and pathways get neighbourhood-level attention first.
The MNP model is the clearest opening for independent providers or third-sector organisations to hold a neighbourhood contract directly, though NHS England has not yet defined the payment terms an MNP would work under. Kent and Medway's contract, by contrast, runs entirely through NHS-commissioned general practice, and its funding envelope covers care delivery rather than the kind of programme or pathway-support work CHASE clients typically build alongside the NHS.
The more immediate read for industry sits in the mismatch between the two tracks. A neighbourhood contract can now move as fast as Kent and Medway's did, using a new flexibility within an existing contract, while the framework meant to standardise the approach nationally is still working out how IHOs, SNPs and MNPs get paid. Programmes designed around a single ICB's neighbourhood priorities have a live example to build from; programmes assuming a settled national contract structure don’t.
Kent and Medway answers one question the framework leaves open: a neighbourhood contract can exist now, funded and running, without waiting for IHOs, SNPs or MNPs to reach a final form. What it leaves unanswered is whether the BMA's objections to the wider framework, over leadership, funding and capital, get resolved before other ICBs try to follow.
The 2026/27 consultations on payment models will decide that. CHASE tracks NHS commissioning changes like this one for pharmaceutical and medtech clients whose commercial and NHS-industry partnership work depends on knowing which ICB is moving and on what terms. Get in touch with our team to find out more.
It is NHS England's plan to organise primary, community and social care around local neighbourhoods with SNPs typically covering around 50,000 people delivered through new Integrated Health Organisation, Single Neighbourhood Provider and Multi-Neighbourhood Provider contracts, and backed by a national target of 250 neighbourhood health centres by 2035.
It is a local variation to the Primary Care Network Directed Enhanced Service, announced in June 2026, worth £10 million a year. It funds proactive care, advance care planning, geriatric assessment and medication review for the 92,000 patients who generate around 30% of local hospital admissions.
An Integrated Health Organisation holds a whole-population budget and can only be an NHS body. A Single Neighbourhood Provider runs care for around 50,000 people and can evolve from a GP contract. A Multi-Neighbourhood Provider coordinates delivery across 250,000 or more people and is open to a wider range of organisations.
The BMA is concerned about secondary care organisations leading primary care, about funding the framework by redirecting existing budgets rather than adding new money, and about using private finance for neighbourhood health centres, which could repeat high long-term costs of the 1990s Private Finance Initiative (PFI).
The near-term opportunity sits in ICB-level decisions being made in 2026/27, not the national contract structure, which remains unsettled. Kent and Medway shows what a live neighbourhood contract looks like, while the payment terms for the framework's own IHO, SNP and MNP models are still being worked out.
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