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PCN focus on GP practices has created a guidance ‘vacuum’ for CCGs, report says


By Jess Hacker
29 June 2021

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The focus on GP practices in formal primary care network (PCN) guidance has left an information ‘vacuum’ in how clinical commissioning groups (CCGs) can support PCNs, a report has said.

Published in the British Journal of General Practice (BJGP) and based on interviews with 37 CCG employees involved in setting up PCNs, the report suggested that official guidance has placed a ‘heavy emphasis’ on negotiating inter-practice agreements and other ‘minutiae’ surrounding contractual payments.

It said that while this is understandable, it has led to ‘something of a vacuum in guidance relating to the role of CCGs in supporting PCNs’.

Positioning PCNs as hubs for other services will ‘require CCGs to act as brokers of relationships, mediators of disputes, and providers of development and management support’, it said.

It added that CCGs are well placed to understand the ‘complexities of local systems’ and to help PCNs work with wider system partners as they merge into larger systems.

‘As CCGs scale up and lose staff, there must be a concern that local, historical knowledge about the system and local trusting relationships and the local links that will be needed for successful collaboration across provider organisations will be lost,’ it said.

Nine CCG mergers were approved in April, reducing the total number of CCGs in England from 135 to 106.

In February this year, the Department for Health and Social Care (DHSC) set out its plans for CCG functions to be overtaken by integrated care systems (ICSs) from April 2022.

Supportive CCG staff ‘concerned about the sustainability’

The study also found that as many as 26 CCGs reported they had allocated some of their primary care teams’ time to support PCNs, including hosting workshops to discuss policy and facilitate local conversations.

Additionally, four CCGs had also agreed to second some of their staff to PCNs to provide skills that PCNs were perceived to be lacking, such as finance and management.

However, staff reported that they were ‘concerned about the sustainability of these arrangements for PCNs and CCGs’.

Similarly, others reported concerns that expectations for PCNs, such as central policy initiatives, were ‘too extensive’ and could lead to professional backlash.

One interviewee said: ‘It has all come too quickly — [PCNs have been] asked to put in place this new entity, employ people, develop new services — it is too much.’

Another said that PCNs were under pressure from multiple organisations across the system: ‘PCNs are like Buckaroo [a children’s game]: people keep piling work on them and everyone wants a bit of them. We need a reality check or we will kill them before they start.’

The study authors said that PCNs need CCG support to work with other providers and to make sure care given meets local needs.

Future iterations of PCN policy need to ‘engage proactively with CCGs’ to ensure that policy development supports this, it said.

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