In the latest blog by Professor David Colin-Thomé, chair of PCC, he considers the single neighbourhood and multi-neighbourhood provider (SNP and MNP) contract consultation. He identifies that a significant role beckons for strategic commissioners if they aspire to be enabling, supportive, sense making and inspiringly proactive. Contracts are necessary, but should underpin relationships, not define them. He considers that the proposals out for consultation certainly offer a vehicle for the paradigm shift necessary to deliver on the welcome aspiration of the 10 Year Health Plan.
David Colin-Thomé
A significant new role beckons for strategic commissioners if they aspire to be less operational: quintessentially, sense-making, enabling, supportive and, dare I say it, inspiringly proactive. An authentic system-leadership role, as equal experts with providers and the public; commissioners as the people’s organisation. Contracts are necessary, but should underpin relationships, not define them. Do the proposed new neighbourhood contracts pass muster? The proposals out for consultation certainly offer a vehicle for the paradigm shift necessary to deliver on the welcome aspiration of the 10-Year Plan.
Single Neighbourhood Provider (SNP) and Multi-Neighbourhood Provider (MNP) contracts
The following quotations are from NHS England (NHSE): “A consultation on proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models to support neighbourhood health services—technical detail to support answering the consultation questions.” Date published: 16/07/2026.
Single Neighbourhood Provider (SNP)
‘Plan and organise NHS services for local people in one neighbourhood. Deliver enhanced primary medical care services. Work closely with, and sub-contract to, GP practices and other local providers. Be part of the local neighbourhood team and lead the health services within it. Work closely with NHS trusts, community health services and pharmacies, local government, providers of wider services (including public health, children’s services, adult social care and housing) and civil society organisations to help join up care and support’.
‘The SNP model builds on current Primary Care Networks (PCNs) but aims to be more focused on local needs; more flexible in how staff and services are organised; broader than just general practice. SNPs may also create the opportunity for additional, locally agreed funding for providers (including general practice). How services could be organised in a single neighbourhood. While keeping the current Contract Directed Enhanced Service (PCN DES), there are three ways local commissioners could organise services around local needs.’ These are fully described in the recent NHSE consultation.
List-based general practice, by dint of its long-standing population responsibility, must retain its identity as a key provider of continuity of care. My imperative for primary care is for it to be indispensable to NHS transformation and to ensure its ongoing centrality to all facets of the NHS. The ambition—with acknowledgement to Professor Donald Berwick’s original work—is a specific triple aim for primary care: to level up quality and increase the range and scope of primary and community service provision; to significantly contribute to reshaping hospital services, which acute providers and commissioners have failed to do; and to have a central role in health and wellbeing beyond healthcare by developing a local public health role for primary care. The SNP is the vehicle, portending a future of devolved enablement, manifest through transparent accountability underpinned by locality budgeting and subsidiarity. Without that paradigm shift, NHS reform will continue simply to be about new structures within a constraining mindset. Community-based care has the potential to be the mainspring of the system of partnerships I envisage for sustainable healthcare. This view is reinforced by those of us currently mentoring nascent neighbourhoods, who are impressed by their energy, commitment and, most importantly, their vision of a partnership-based, accountable and sustainable future.
Multi-Neighbourhood Provider (MNP)
‘MNPs will use their scale to design and co-ordinate neighbourhood health services in their footprint, which may include delivering NHS services directly at a larger scale than a single neighbourhood, or ‘filling in’ services within a single neighbourhood where it is locally agreed to be more appropriate for an MNP to deliver. It is our working assumption that an MNP Contract, while optional, could work well at a footprint of around 250,000 people or more, but we do not propose to mandate a national size’. And radically: ‘An MNP would: Plan and organise NHS services that include both primary medical and non-primary care elements across several neighbourhoods (usually covering around 250,000 people or more); Work closely with local providers, including Single Neighbourhood Providers (SNPs), GP practices, community health services and pharmacies; NHS trusts, local government services, civil society organisations and wider public services; Manage how any incentive payments are shared across those providers; Help make sure services are consistent and work well together; Provide some NHS services directly. MNPs may also create the opportunity for additional, locally agreed funding, for providers (including general practice)’.
Further welcome evidence of a light-touch policy is the statement: ‘We want to: avoid making things too complex, make it possible for smaller organisations to hold MNP Contracts’. This allays my initial fear of MNPs having hierarchical control of SNPs. Even though this is clearly not policy, heightened awareness is required of the probable NHS assumption of such a traditional hegemonic role for the larger organisation. Devolution can be a harbinger of a more localised centralism.
While supporting subsidiarity for SNPs, list-based general practice and any other population-responsible organisations, I envisage an immediate role for MNP contracts. The recent Alan Milburn NEET report (DWP 2026, ‘Young people and work: interim report’) reveals a public-sector failure to work coherently together for the individual citizen. A similar failure is likely to be highlighted with the Prime Ministerial focus on homelessness. An MNP contract, while no guarantee of successful partnership working, could provide the framework to encourage such an outcome. ‘There could potentially be more than one MNP Contract within a single geography.’ And: ‘By agreement with local authorities, an MNP or SNP Contract could also include direct responsibility for some services commissioned by local authorities.’
I mention NEET because I would be surprised if it were not a major government focus. Economically, politically and socially, we can’t afford—in all its meaning—one million and rising disenchanted young people. The more policies that can be delivered locally, the more this will emphasise the centrality of GPs and other community-based providers. It’s an approach I recommend: think strategically, deliver locally. Contracts must be enablers, and local providers must be trusted, in contrast to the culture of current operational commissioning.
Promisingly, this appears to be the zeitgeist of our refreshed government.
Professor David Colin-Thomé is chair of PCC.
PCC supports PCNs, federations, integrated care boards, trusts, local authorities, and local communities develop neighbourhood working, ensuring they are fit for the future. Contact enquiries@pcc-cic.org.uk to find out more.
