Neighbourhood health is a good idea. In fact, it’s an excellent one. I have yet to meet a single doctor, nurse, or community colleague who thinks that moving more care out of hospitals is a bad thing. Not one.

We all know the truth: hospitals are risky places for patients who don’t need to be there. Delays cause harm. Long waits worsen outcomes. And without reform, we will bankrupt the country. The range of treatments we can now offer is vast and ever-expanding, and the NHS delivers an extraordinary amount of high-quality care on an incredibly tight budget.

So with all that in mind, why is it taking so long to get clarity on how neighbourhood contracts are supposed to work?

We have GP-at-scale providers ready to go. We have integrated neighbourhood teams already assembled, experienced, motivated, and keen to take on more. This is quite literally the only thing the profession broadly agrees on: neighbourhood working is the right answer. What we are doing now is not just outdated — it is actively harming people.

If the evidence showed that the status quo produced better outcomes, then caution would be understandable. But it doesn’t, so why do we keep doing it?

I suspect I know why.

The old mantra still dominates: acute trusts cannot fail. The fear is that the big, shiny hospital buildings — the places in which we have invested so much money, status, and emotional capital — might be destabilised if community teams truly deliver on the neighbourhood promise.

I suspect that this isn’t really about patients. It’s about power. And a fundamental lack of understanding of what community teams can do.

Time and again, we have proven that we are agile, innovative, and creative in how we work with our populations. We created PCNs almost out of thin air, armed with little more than goodwill and some ARRS funding.

We vaccinated a nation at record speed during Covid. In my own patch, we turned a football club and a Masonic hall into a vaccination centre.

We are remarkable.

And yet, despite all this evidence, we are once again being sidelined from decisions about our own future.

I suspect our success is also our Achilles heel.

Three letters: QOF.

Possibly the biggest single public health intervention of my career — and we delivered it. We delivered it too well. It improved outcomes, reduced variation, and saved lives. It also cost the Treasury a lot of money.

Never mind the workforce required to do it. Never mind the systems, the recalls, the relentless follow-up. Forget the nurses making sure every diabetic’s feet are checked, every child is vaccinated, every chronic condition is optimised. This triumph of primary care has never really been forgiven. And I honestly believe that cloud has hung over my entire career as a GP.

So, I have one thing to say to the Treasury: get over it.

You have seen what we can do when we are properly funded. Now let us do it again. Fund the left shift.

Our own acute trust, Princess Alexandra Hospital, Harlow, has been really supportive and is willing to work with us to resolve this issue of left shift.

None of my patients want to go to hospital if they can avoid it. None want to access specialist care via an emergency department.

But right now, it often feels like the only way to see a specialist without waiting 18 months for an outpatient appointment that will probably be cancelled anyway.

An elderly patient came to see me recently clutching her cardiology outpatient letter. She said, proudly, ‘I’ve got it — in 11 months’. She is 89 years old, with heart disease. Eleven months is less a waiting time and more a test of survival.

We laughed. We cried. And I will continue to hold her care — unsupported, unfunded, and unseen — until her outpatient appointment in 2027.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.