Integrated Care Boards across England are confronting a structural mismatch between existing GP networks and the government's neighbourhood health programme, with Primary Care Networks in multiple areas lacking the coherent geographic boundaries needed to take on new local care contracts. The problem is compounding delays that have already pushed the rollout of neighbourhood provider contracts well beyond their originally intended timeline.

Primary Care Networks are collaborative groupings of GP practices that were established from 2019 to coordinate local services. They were formed largely around practice membership rather than strict geography, which made sense at the time but has created an awkward inheritance. As the government moves to organise NHS services around defined neighbourhood populations of roughly 50,000 people, a number of existing networks do not map cleanly onto those areas. Some cover fragmented patches. Others overlap with adjacent networks in ways that make it impossible to assign a single, coherent geographic contract to them.

The 2026/27 Network Contract Directed Enhanced Service now requires PCNs to work with their ICB to better align registered lists with neighbourhood boundaries, though NHS England has said this is intended only for cases where current geography does not reflect local communities and is not meant to disrupt well-functioning PCNs with geographically contiguous boundaries. In practice, the line between limited correction and wider disruption is proving difficult to hold.

NHS Confederation members have raised concerns that further guidance is needed to avoid permissive arrangements that create misalignment, and that any systems redrawing PCN boundaries must be careful to avoid generating disruption that detracts from service delivery. The warning reflects a tension that ICBs are navigating in real time: the structural work of realignment and the operational work of running services cannot easily happen simultaneously.

The boundary problem is unfolding against a backdrop of organisational upheaval within ICBs themselves. ICB changes came into effect on 1 April 2026, including a reduction from 42 to 36 boards, following the government's requirement that ICBs cut running costs by 50 per cent. This is expected to result in around 12,500 fewer staff across the health system. Asking already reduced ICB teams to manage network reorganisations on top of their own structural changes is placing significant strain on local planning capacity.

The patient consequences are bound up with the fate of the neighbourhood contracts themselves. Neighbourhood provider contracts promised for 2026 will not now arrive until 2027/28 at the earliest, and a public consultation still needs to take place first. That delay means the integrated neighbourhood teams intended to join up primary, community, mental health, and social care services in a single local framework are not yet operational in most areas. Where PCN boundary misalignment has not been resolved, the delay is likely to extend further still, since awarding a geographically defined contract to a network whose footprint does not reflect that geography creates accountability problems from the outset.

With nearly £300 million in funding transferred from PCNs back to individual practices under the 2026/27 contract, there is growing uncertainty about what role PCNs will play in their existing form as the NHS moves toward the new neighbourhood structures. Some may evolve into single neighbourhood providers. Others may merge or be absorbed. The framework published in March 2026 sets out this direction but commits to a further consultation on how PCNs transition, without confirming a date for that process.

The NHS Confederation has noted a perceptible lag in the rollout of neighbourhood health contracts compared to the pace at which integrated healthcare organisations and advanced foundation trusts are moving forward, suggesting the reform is developing unevenly across different parts of the provider landscape. For patients, that unevenness carries a practical risk: the degree to which local services are integrated and accessible will increasingly depend on how far advanced each local area is in working through these structural questions.

NHS England has not yet published detailed guidance on how the transition from legacy PCN arrangements to the new neighbourhood contracting model should be managed without disrupting day-to-day patient services. That gap is what ICBs, GP leaders, and local commissioners are currently trying to navigate without a settled framework beneath them.