I once had a HORRIBLE teacher called Mr Fountain. He cast an insecurity in me that stayed for years. He shared in a school report, “whilst Tara is bigger and slower than her peers, she doesn’t let it get her down.” (How rude!!!!!!!!!).
Whilst I can’t change my height, the slowness in my thinking, the thing he made me feel ashamed of, forces me to break things down. More importantly, it forces me to revisit things.
I think on paper and love an infographic 😊.
I need to understand how the puzzle pieces fit together, and today, I find myself doing exactly that now, revisiting the acronyms and the jargon that now define how we’re supposed to organise healthcare in England.
My vantage point is general practice and primary care networks, so those of you from social care, the voluntary sector, secondary care, etc., will see things differently, which I am keen to learn from by sharing my thoughts, testing my understanding, and inviting comment and criticism.
Selfishly, this makes me better at my job. But I like to think it creates a virtuous cycle. I share my learning through blogs and podcasts, and collectively, that sharpens our thinking further.
So here we are. Back to basics.
Terminology
The 10 Year Health Plan introduces a significant amount of new terminology that we’re all expected to understand and work within. The problem is that much of this language has been designed at the system level, and it doesn’t always land clearly when you’re trying to sell the vision.
So I’ve been working through it. Testing whether the pieces actually fit together. And I want to share some of the gaps and questions that have emerged, not because I have all the answers, but because I suspect I’m not the only one wondering.
The helicopter view
The three-tier model
The new architecture operates across three geographic tiers: System (500,000 to 3 million people), Place (250,000 to 500,000), and Neighbourhood (30,000 to 50,000). Each tier has its own set of organisations and acronyms.
At System level, we have the Integrated Care Systems (ICSs), Integrated Care Boards (ICBs), Integrated Care Partnerships (ICPs), and the emerging Integrated Health Organisations (IHOs). The ICBs are being told to cut running costs by 50% and shift towards ‘strategic commissioning’—whatever that means in practice. Some are clustering, some are merging.
At Place level, we have place-based partnerships, Provider Collaboratives, and Health and Wellbeing Boards (HWBs). Place is described as ‘the engine for delivery and reform’. This is where local authority boundaries typically align, and where integration between health and social care is supposed to happen.
At the neighbourhood level, we have primary care networks (PCNs), GP Federations, Integrated Neighbourhood Teams (INTs), Neighbourhood Health Centres, and the new single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) contracts, due to launch this year (2026).
Health and Wellbeing Boards
The Health and Wellbeing Board (HWB) is listed as a key organisation at the Place level. It’s a statutory committee of each upper-tier local authority, established back in 2012. It brings together elected members, NHS leaders, directors of public health and adult social care.
HWBs don’t commission services directly and don’t hold budgets. They produce the Joint Strategic Needs Assessment (JSNA) and the Joint Local Health and Wellbeing Strategy. They sign off on Better Care Fund plans. They influence, but they are not supposed to direct.
So, where does this leave lower leaders not in the HWBs?
If we’re serious about population health, about understanding local need, about engaging with the wider determinants of health, debt advice, employment support, the things that Neighbourhood Health Centres are supposed to offer, then we need to understand where those strategic conversations happen. And for many of us, HWBs have not been overly visible.
The JSNA is the statutory mechanism for formally assessing local population health needs. It should inform integrated neighbourhood strategies and operational plans.
But how many Clinical Directors and management execs have actually read their local JSNA? How many know when their HWB meets, or who sits on it?
And for those who sit on the HWB, how does the information and decision-making filter down?
Understanding the JSNA
The Joint Strategic Needs Assessment is a statutory assessment of the current and future health and social care needs of the local population.
It’s produced jointly by the local authority and ICB, bringing together data on demographics, health outcomes, service use, and wider determinants to identify local priorities and inequalities.
SNPs, MNPs, and what they mean for general practice
The new single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) contracts are designed to enable primary care to deliver at scale. The language suggests that federations and primary care collaboratives are expected to be key candidates for holding the SNP contract.
But SNPs can also be held by acute, community, or mental health trusts. The policy says this depends on ‘where local integration models prefer’. Which raises an obvious question: who decides what the local integration model prefers, and based on what?
I’m not sure about the multi-neighbourhood provider contracts. I believe there will be a lot of variation across the country as to what organisations hold these.
These are governance questions. And they matter enormously for the future of primary care.
Getting governance right
This is exactly why I’m hosting a webinar with Ruth Griffiths, Partner at Hill Dickinson, on Thursday, 29th January from 1pm to 2pm. We’re calling it Directors, Representatives & Stakeholders: Getting Governance Right for Neighbourhood Working.
Ruth brings the legal and structural expertise; I bring the primary care perspective. Together, we’ll work through the governance questions that sit underneath all this terminology, who holds what, who decides what, and where accountability actually lands when things go wrong.
If you’re a primary care leader, a federation director, or anyone trying to work out how your organisation fits into the new architecture, this is the practical follow-up to the terminology breakdown above. I’d love you to join us.
Register here: https://bit.ly/NeighbourhoodRepresentativesWebinar
The virtuous cycle
I’ll keep revisiting this. The terminology will evolve, the implementation will throw up new questions, and I’ll keep breaking it down and sharing what I find. If you spot something I’ve got wrong, or a piece of the puzzle I’ve missed, please KINDLY tell me. This is what collaborative leadership looks like 😊.
Finally….Two questions:
1️⃣ How visible is your Health and Wellbeing Board to primary care where you are?
2️⃣ And who do you think should hold the SNP (Single Neighbourhood Provider) or MNP (Multi-Neighbourhood Provider) contract in your area?
