Who Runs a Neighbourhood? Single vs Multi-Neighbourhood Provider Contracts Explained

Neighbourhood health follows the same three big changes set out in the wider 10 Year Health Plan: moving care from hospitals into communities, from paper and phone calls to digital tools, and from treating sickness to preventing it. The framework turns these into a minimum set of things every ICB must deliver, plus extra goals each area sets for its own population. 

To pay for this kind of joined-up care, ICBs need a contract that makes one provider, or a group of providers, responsible for results across a whole population, not just one service. Two new contracts do that. 

A Multi-Neighbourhood Provider, or MNP, contract would cover a bigger population, usually 250,000 people or more. It's proposed for larger organisations built to work at that scale, coordinating primary care, community, hospital and mental health services across several neighbourhoods. 

Shared back-office support, data systems and quality checks are cheaper and easier to build once, at scale, than for every smaller provider to build them separately. An MNP would need to be a single accountable legal entity, commissioned under the NHS Standard Contract via a new Neighbourhood Schedule; a collaboration of providers would need to nominate a lead provider or set up an umbrella entity to hold the contract on its behalf. 

Above both sits a third model, integrated health organisations. Where an IHO is in place, it would take on resource allocation and service planning for a whole population, and would likely contract for neighbourhood health services underneath it through SNP and MNP arrangements. This piece focuses on the two contracts most providers are likely to encounter directly.

NHS England's consultation sets out two ways an MNP could run: a coordination model, where existing contracts with GP practices and other providers stay in place and the MNP simply helps them work together, and a lead provider model, where the MNP takes full contractual responsibility across neighbourhoods. Some systems may start with coordination as a stepping stone toward the clearer accountability of a lead provider model. 

Locally, there are three proposed ways to organise SNP delivery: keeping a version of the current Primary Care Network arrangement, ICBs contracting directly with SNPs, or an MNP coordinating and sub-contracting to SNPs underneath it. 

NHS England has said it wants smaller organisations to be able to hold MNP contracts, not just large-scale providers, and that ICBs must confirm local GP support within relevant SNPs and neighbourhoods before awarding an MNP contract. Legal and GP representative bodies reviewing the proposals have flagged the practical risk that procurement processes still tend to favour larger, more established providers, whatever the stated intent. 

Providers already working through general practice will want one reassurance in particular: core GP contracts, GMS, PMS and APMS, are explicitly not being replaced by any of this. Existing Primary Care Network investment, including ARRS funding, is expected to be protected during any transition. What the proposals say less about is what determines whether a contract delivers genuine joined-up care in practice, rather than primary care at scale with social care and voluntary sector partners added on afterwards.

Both contract types are described as outcomes-based. This is a move away from block contracts, which have long paid providers for community and primary care services regardless of results. Instead, providers will be judged on population-level measures, like fewer ambulance call-outs for high-priority patients and faster hospital discharge, rather than how much activity they deliver. 

This changes how providers will need to plan and report. That said, the details of how those results will be measured, and how payment will follow them, are still being worked out nationally.

The framework asks ICBs to actively move resource from acute services into neighbourhood care over the Spending Review period, backed by changes to block contracts and payment flows from 2026 to 2027. Rather than waiting for new money, this is about rebalancing what systems already have, with room for local proposals for new payment models where they're backed by credible plans. 

What's still missing is the detail underneath that principle. NHS Confederation and other sector bodies have already asked how funding and payment will work in practice for SNP and MNP contracts specifically. DHSC and NHS England have said they'll set out a payment approach for ICBs to use, but that detail hasn't been published yet. 

Delivery runs in two stages. Stage one, through the 2026 to 2027 financial year, asks ICBs to agree foundational plans covering urgent and community capacity, general practice access, neighbourhood team footprints and Better Care Fund alignment with local authorities.  

With the consultation on SNP and MNP contracts now closed, NHS England has said a further consultation on the final detail of both contracts is expected later this year, before the first contracts start appearing.  

Stage two, from April 2027 to March 2029, moves systems towards locally owned neighbourhood health plans. The outcome of that further consultation, and early examples of how ICBs are setting these contracts up on the ground, should tell us more over the coming months than the current proposals do on their own.