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PCNs’ success ‘not subject to top-down imposition from commissioners’


By Lea Legraien
1 July 2019

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Primary care networks (PCNs), which come into being today, should be ‘owned and designed’ by GPs and their teams rather than being subject to ‘top-down imposition from commissioners’, the Royal College of General Practitioners (RCGP) has said.

The college added that PCNs should ‘allow GP practices to pool clinical and administrative resources’, helping to free up GPs’ time and improve access to other integrated services.

But the RCGP also warned that there is no ‘one-size-fits-all’ solution to address the issues general practice currently faces, pointing out that some practices will need more resources than others to grow further.

As part of the new five-year GP contract, practices will be provided with extra funding to join networks, serving between 30,000 and 50,000 patients, with the aim for PCNs to cover 100% of the population.

Although joining a network was not mandatory, the level of participation has been quite high, with 99.7% of GP practices signing up to the network DES contract, according to NHS England.

RCGP chair Professor Helen Stokes-Lampard said: ‘It is essential that for PCNs to succeed, they are owned and designed by GPs and our teams – not subject to top-down imposition from commissioners. We are part of our local communities and are best-placed to understand our patient populations and their needs.’

‘PCNs are essentially groups of practices working together and aiming to work with other agencies to deliver improved care for patients – and collaboration can have great benefits, particularly at a time when general practice is facing such intense resource and workforce pressures.

‘Working in networks should allow general practices to pool clinical and administrative resources, as well as making it easier to introduce truly multi-disciplinary teams – ultimately it should help to free up GPs’ time to spend with patients who need us most, and improve access to more integrated services for our communities.’

She added: ‘However, there is no “one-size-fits-all” approach to resolving the pressures facing general practice, and while structural reorganisation like this can be positive for surgeries with sufficient resources, others will need a lot more support and time to develop.

As of Friday 27 June, NHS bosses reported that more than 30 practices that wished to join a network were still in negotiations to ‘get their home sorted’ before adding that this number was expected to drop to one come today.

They estimate that a further 26 practices have also refused to join a network altogether, which brings the total number of networks across the country to 1,259, with 83 of those below the 30,000 threshold. Of these, 26 cover less than 27,000 patients – and two in scarcely populated areas Cumbria and Yorkshire under 20,000.

There is also a ‘significant number’, as yet unknown, of networks above the 50,000 population guideline.

According to NHS England, practices refused to join a network for various reasons including:

  • Unwillingness to end half-day closing, which is a requirement for all network members;
  • Unwillingness to partner;
  • Not wanting to grow their business and take on associated responsibility;
  • Major concern about the level of additional future workload.

BMA GP committee executive team member Dr Krishna Kasaraneni said: ‘PCNs provide a viable alternative, based on the existing GMS contract, and are the vehicles for general practice to come together and therefore resist vertical integration by being forced into salaried employment for an NHS provider.

‘GPs can ensure that we, the profession, protect and enhance the independent contractor model of general practice by working together and demonstrating that it does and will deliver for our patients.’

A version of this story was first published by our sister publication Pulse.

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