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What next for primary care networks

Nationally some primary care networks (PCNs) are finding themselves increasingly hamstrung by the lack of any clear policy direction by NHS England and with the upcoming GP contract review there is uncertainty as to what is coming next. We know the five years of the PCN directed enhanced service (DES) ends in March 2024. Given the position of the Government and next elections will the contract review be a mere role forward for a year or a full five-year refresh?

William Greenwood
William Greenwood

The question is whether it is worth investing time and effort into the PCN given the chance that things may all change again in a little over nine months. Life for PCN clinical directors, managers and leaders is tough enough, without having this additional uncertainty to contend with. How real is this uncertainty, and how likely is it that PCNs will be replaced by something new in just a few months’ time?

What is the big picture? Our NHS has entered the new world of integrated care systems (ICSs). It is fair to say that even those working in these new bodies are finding it hard to fully get their heads round what they are supposed to be doing. The latest noise from the Government following the Hewitt Report on ICSs suggests that they are going to remain the overall direction of travel for the NHS into the near future, irrespective of the potential change of Government.

ICSs are built on the notion that all the different parts of the NHS system (and to an extent local government) work together in partnership to improve the delivery of care for patients. General practice is one of these parts of the system. Historically the system has found it impossible to partner with the multitude of GP practices across the country, which was the main driver behind the introduction of what is now 1200 plus PCNs established (at least in theory) around neighbourhood areas.

Given the ongoing push for partnership working across the NHS, it therefore seems highly unlikely that there will be a backward step from the joint working between practices that PCNs have created. While this will undoubtedly be much to the disappointment of the many GPs and practices who dislike the requirement to work with other practices through PCNs, this unpopularity will not result in a national reversion to practices as the primary unit for the delivery of resources into general practice.

We will see a move to strengthen the joint working between practices across neighbourhood areas that has been developed over the last five years by PCNs. The question is whether this will remain as PCNs per se, or whether these will be changed into something else. The biggest clue we have as to that question is in the Fuller Report, which states that PCNs are to “evolve into” integrated neighbourhood teams. It describes these in this way,

“This is usually most powerful in neighbourhoods of 30-50,000, where teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams, and domiciliary and care staff can work together to share resources and information and form multidisciplinary teams (MDTs) dedicated to improving the health and wellbeing of a local community and tackling health inequalities.” Fuller report p6.

The key question appears to be whether an integrated neighbourhood team replaces the PCN, i.e., once there is an integrated neighbourhood team there is no longer a PCN, or whether the PCN represents the group of GP practices that are participating as a group in the local integrated neighbourhood team, which has a much wider group of participants than the PCN. This latter option appears to be the one being adopted by those places that do claim already to have integrated neighbourhood teams.

So, the outcome is that PCNs remain. Even Labour’s health policy is to create a “Neighbourhood Health Service”, which very much looks like it has PCNs at the centre. In fact, given the current policy void, it is hard right now to envision a future in which there is not something PCN-shaped that continues to be the conduit for most additional resources coming into general practice.

While none of us know for sure what the future holds, it does seem a safe bet that NHS England and the Government will want to build on the progress they have made through PCNs beyond March 2024. There is a chance that the name will change, but it seems extremely unlikely that the scale of working will alter as there have been no pointers in any other direction. The pressure for the PCN unit to build more effective partnerships with system partners will undoubtedly grow, but the core unit of the group of practices as a PCN seems destined to remain.

William Greenwood, chief executive, Cheshire LMC, and governing body member of PCC.

Last Updated on 1 August 2023