By now, we hardly need another grand description of the ‘future’ neighbourhood model of care. Most of us in primary care can see it clearly enough.
The emerging neighbourhood model is attractive because it builds on what general practice and primary care networks (PCNs) have been trying to do for years: co-ordinate care, offer something comprehensive, and sustain continuity where we can. It is rooted in communities, more personalised, and organised around people and place rather than organisational silos. That vision matters. It is motivating. It reflects the direction many PCNs have already been moving in – often despite the system, not because of it.
But motivation is only half of what drives change. The other half is confidence and across primary care, that confidence is fragile because the practical conditions to deliver it are still unclear.
That is where the debate now needs to move. We should spend less time describing the model we want, and more time specifying how it will actually work for practices and PCNs on the ground.
Because if neighbourhood health is going to be real, it will not be delivered by goodwill alone. It will be built through the way everyday work is organised in general practice, across PCNs, and with partners.
Take co-ordination. In most PCNs, a significant amount of time goes into joining things up – chasing information, aligning input from different services, supporting patients who fall between gaps. But this work is often informal, unfunded and dependent on individual effort. If neighbourhood care is to function properly, co-ordination has to be treated as core infrastructure. That means having identifiable roles, protected time, shared approaches to case finding, and clear routes for escalation when complexity arises. Without this, we will continue to rely on receptionists, care navigators and GPs to hold the system together through work that is largely invisible.
The same applies to the tools we use. Many PCNs are trying to run multidisciplinary teams across organisations that still cannot see the same records, access the same data, or contribute to a single care plan. Practices often end up coordinating care with partial information and multiple logins while trying to maintain safe continuity. Shared records, interoperable systems, and live, usable population health data are not optional extras – they’re what make a neighbourhood model possible. Without them, collaboration is slow, duplicative and fragile.
Multidisciplinary working has to be more than a meeting in the diary. PCNs have made real progress here, but the variation is stark. In some places, teams actively manage defined cohorts with clear roles and follow-up; in others, meetings remain largely conversational, with limited ability to translate discussion into action. For neighbourhood working to deliver, the structure needs to be tighter: agreed population groups, regular review of those with higher need, and clarity about who is responsible at each stage. This is not about adding bureaucracy; it’s about making the work functional.
Then there is the question of incentives. Practices are still operating within a framework that rewards activity, access metrics and organisational performance, while being asked to invest time in prevention, co-ordination and relationship-based care. PCNs sit in the middle of this tension. If we are serious about shifting care, funding flows need to support that shift – giving practices and PCNs the confidence to invest time and resource in proactive, team-based care without destabilising core delivery.
Measurement is part of the same problem. Much of what gets counted doesn’t reflect the work PCNs are trying to do. Continuity, co-ordination and team-based care are central to the neighbourhood model, but they remain peripheral in how success is judged. On the ground, this pulls teams back towards what is easily measured rather than what is clinically meaningful. If we want different behaviour, we need different signals.
Importantly, changes need to feel doable. For many practices, the experience of the past few years has been one of accumulating asks, fragmented programmes and limited headroom. PCNs have often acted as the shock absorber, translating national ambition into something deliverable locally. That role is valuable, but it is not sustainable without better support. Simplifying expectations, aligning priorities and providing practical improvement capability would go a long way to rebuilding confidence.
None of this is especially mysterious. Anyone working in a PCN can describe where the friction lies. The issue is not a lack of insight; it’s the lack of consistent follow-through in addressing the operational barriers.
That is why confidence now matters as much as motivation. Primary care teams will commit to this direction – they already have – but they need to see that the system matching their effort with the right tools, incentives and support.
There is good reason to be optimistic. The neighbourhood model reflects the best of what general practice stands for and what PCNs have been trying to build.
But if it’s to become more than a policy narrative, we need to be much more concrete about the how – not just what we want to build, but how it will work on a wet Wednesday morning in a busy practice.
Because ambition creates motivation. Delivery requires confidence.
Dr Duncan Gooch is chair of the Primary Care Network at The NHS Alliance and managing partner and clinical director of Erewash Health Partnership, a consortium of practices that provides healthcare services to over 100,000 people.