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NHS England has now approved Kent and Medway's request to offer GPs a local variation to the Network Contract Direct Enhanced Service (DES) that will deliver GP-led single neighbourhood care through the existing PCN arrangements.

This variation was developed jointly by NHS Kent and Medway Integrated Care Board (ICB) and local GP representatives, Kent Local Medical Committee (LMC) to simplify arrangements, reduce fragmentation, strengthen continuity of care and unlock nearly £10 million of new annual investment to support patients with the most complex needs across Kent and Medway.

The local variation is designed to support general practice to lead new single neighbourhood arrangements, focused on improving outcomes for people with the most complex health needs and is the first use of this power nationally.

The new contract offers practices greater professional freedom, simpler requirements, and sustainable funding, while retaining existing GP core contracts.

At the heart of the offer is significant new investment in general practice. Despite facing some of the toughest financial pressures of any NHS system in England, Kent and Medway's leaders have prioritised investment in primary and community care as a cornerstone of future sustainability.

Initial focus of the neighbourhood health model
The initial focus of the new neighbourhood health model will be around 92,000 patients in the most complex care cohorts, including care home residents, people on palliative care registers, and housebound patients living with severe frailty.

For these patients, practices will provide proactive interventions such as:

• advance care planning discussions
• comprehensive geriatric assessments
• structured medication reviews.

Although this group represents around 5 per cent of the Kent and Medway population, they account for around 30 per cent of hospital admissions and often experience longer hospital stays. Extended stays can lead to deconditioning and worsening frailty.

By providing proactive, wraparound care in patients' own homes or usual place of residence, the model aims to improve outcomes and reduce unnecessary hospital admissions.

Practices taking up the contract will build on the clinically agreed model, developed with partners across the NHS system as well as evidence-based interventions already proven through local schemes.

Adam Doyle, chief executive of NHS Kent and Medway, said, “We recognise that to make improvements in Kent and Medway we need to do real transformation and have been working with partners across and outside of the NHS to understand how we might make the shift. We have had strong support across the system to change the way we do things within our four layers of care in which general practice is a significant part. We have  been working with stakeholders on the model we want to embed, to bring care closer to people's homes. As ICBs take on a stronger strategic commissioning role, we think we should be brave and start that process where we know it can make the most difference to people's experience of healthcare and the outcomes they experience.”

Dr Gaurav Gupta, chair of Kent Local Medical Committee said, "Kent LMC and NHS Kent and Medway have worked closely together to agree the Kent variation of the PCN DES which puts list-based general practice at the heart of neighbourhood health in the county. We have agreed meaningful new investment into general practice to deliver evidence-based care to our most vulnerable patients. This single neighbourhood model will allow practices and primary care networks to build upon the good work they are already doing, further improving outcomes for our communities."

This new contract offer represents a strong vote of confidence in general practice and its critical role in delivering high-quality, joined-up care for local people. NHS Kent and Medway has confirmed that, for practices choosing to take part, the level of investment offered will be considered a minimum floor for future funding.