Alongside the Neighbourhood Health Framework, NHS England has now published Fit for the Future: Towards Population Health Delivery Models – a technical but important blueprint that explains how neighbourhood‑level care will actually be commissioned and funded over the coming years. While the Framework focuses on how services should work on the ground, this new document sets out the contracting architecture behind it, including the move to Single Neighbourhood Providers (SNPs), Multi‑Neighbourhood Providers (MNPs) and Integrated Health Organisations (IHOs). These models are intended to reduce fragmentation, align incentives and shift more resources into prevention and community‑based care. For general practice, understanding this emerging landscape is essential: it will shape how neighbourhood services are built, how resources flow, and how primary care’s voice is positioned within the wider system.
The publication of Fit for the Future: Towards Population Health Delivery Models marks the next major step in the NHS’s shift toward neighbourhood‑level, preventative, joined‑up care. While the Neighbourhood Health Framework explains how care should be delivered, this companion document explains how the system will be commissioned and funded to make that model real.
For general practice, this is about understanding the new contracting landscape – SNPs, MNPs and IHOs – and what they mean for influence, workload, and the future shape of local services.
NHS England is clear that the current system is too fragmented, with multiple contracts covering different footprints, misaligned incentives, and an imbalance of resources favouring acute care. The document states that “services are fragmented across multiple contracts… making it harder to move activity, staff and money between organisational boundaries” .
The new models aim to fix this by commissioning providers around defined populations, not organisational silos.
The publication introduces three contract types that will sit alongside existing GMS/PMS/APMS arrangements.
SNPs will deliver services for a single neighbourhood (typically 30-50k population) through integrated neighbourhood teams. They will enable primary care to take on new neighbourhood‑level services “that are not contracted through today’s general practice contracts” .
For GPs, this is the closest to day‑to‑day practice: SNPs are the mechanism through which neighbourhood‑level services will be built around registered lists.
MNPs will coordinate services across several neighbourhoods, ensuring consistency and filling gaps where an SNP “is not willing or able to deliver” .
They will use scale to design services, support sustainability, and manage risk‑sharing arrangements that reward prevention and reduced avoidable admissions.
IHOs are the biggest shift. They will hold a whole‑population health budget for a defined geography, taking responsibility for resource allocation, subcontracting, and pathway redesign. The document notes that IHOs “will undo needless NHS fragmentation and create incentives to invest in community‑based preventative care” .
Only NHS organisations can hold IHO contracts, but neighbourhood providers may partner with them or even form new NHS organisations in future.
For GPs, the key implications are:
This is not a reorganisation of general practice contracts, but it is a reorganisation of the system around general practice.
The document describes a future where empowered providers lead end‑to‑end pathways, supported by shared data and actuarial analysis. ICBs remain strategic commissioners, but IHOs take on the operational responsibility for designing and delivering care models across neighbourhoods.
The ambition is for “all areas of the country to be covered by an IHO contract” and for neighbourhood‑level models to become the default way services are delivered.
Doncaster LMC is already engaging with system partners to ensure these new models strengthen general practice rather than dilute it. We are:
Our priority is simple: to make sure Doncaster’s version of these models works for practices, protects professional autonomy, and improves care for our communities.