I was amazed when I heard that the BMA’s Annual Representative Meeting had voted in favour of GP practice withdrawal from PCNs by next year.  The motion for the, “GPCE and the BMA to organise the withdrawal of GP practices from the PCNs by 2023” was passed with 61% voting in favour, 12% against and 27% abstaining.

The context for this is that we are currently in year 4 of a 5 year contract deal, agreed in 2019.  By the time we reach the point at which this withdrawal is to happen it will be for the last year of the existing deal.  The majority of the benefits of this deal for general practice sit within the PCN DES, and so the call is for general practice to withdraw from the part of the deal with the biggest benefits for its last year.

I cannot be the only one thinking efforts might better be focussed on negotiating the next deal, rather than putting a huge amount of effort into raising concerns during the last year of the existing deal.

We already know that NHS England is not going to negotiate around the existing deal.  Last year was the first year we did not have a negotiated agreement between the GPC and NHS England.  It will not be any different this year, as they will argue exactly as last time that the current deal was already agreed to four years ago.

The wider context is that we have Integrated Care Systems (ICSs) wanting to take control of GP and in particular PCN funding.  The system can see the extra money that is being put in through PCNs, and in particular through the ARRS, and wants to get its hands on it.  Remember £1.8bn of the additional £2.8bn negotiated in 2019 comes through PCNs.

This creates a fairly happy set of scenarios for NHS England.  They can offer to take PCN funding out of the national contract next year so that it can be “topped up” locally by ICSs, thereby increasing the funding going into PCNs and accelerating their development into Integrated Neighbourhood Teams (as per the Fuller Report).  Very little of any extra money would make it to practice level, and the cost would be a big shift away from a national contract and a worrying precedent set ahead of the next 5 year deal.

Alternatively NHS England can give the PCN funding to ICS areas directly (if practices say they do not want it), for them to either route back through general practice or put it through a local lead provider type model.  If general practice does not want the PCN money or staff, then the system I am sure will be happy to take it.  At this point it would be hard to see any other route for general practice to survive other than via integration into other providers.

The LMC motion that was passed in full also calls for, “PCN funding to be moved into the core contract”.  The problem is that this is outside of the control of general practice and is not something that NHS England or the government is going to agree to.  If what the system wants is a general practice that can actively partner with other providers then the last thing it is going to do is act to strengthen its independence.

Withdrawing practices from PCNs at this point in time would be a huge own goal for general practice.  I understand the resentment and dissatisfaction that exists within many practices towards PCNs, but if the aim is to preserve the independence of general practice then this is politically naïve and a move that will do far more damage than good.