There is a danger starting with a title like this that it will provoke many into further calls for general practice simply to abandon PCNs and have nothing more to do with them.  This was the call at the national LMC conference, and as I understand it has become BMA policy.  But as I have previously written, such a move has the ‘cutting off your nose to spite your face’ feel to it, and a more nuanced approach is required.  So what could this be?

The challenge is that all of the additional funding and resources for general practice over the course of the current 5 year deal comes via PCNs, and general practice simply cannot afford to do without this.  Any move away from PCNs will not result in the funding being transferred into the core contract, but in a loss of control of these resources to other organisations eager to take them on.

We know that the Fuller Report has laid out a direction of travel for PCNs to evolve into Integrated Neighbourhood Teams.  This means the focus of PCNs moving away from GP practices and towards multi-agency working across local neighbourhoods.

What will happen to the funding of PCNs after the existing 5 year deal for general practice expires in 2024?  The funding for them will potentially grow (neighbourhood multi-agency working is becoming more not less important to the system), and will most likely continue to consume any additional funding for general practice.  It is also highly likely to come via the local Integrated Care System rather than via the national contract.

So the additional money for general practice is, and will continue to be, tied up in PCNs, but the control of PCNs may start to shift away from practices.

I have written previously of the need for local general practice within each area to start to work together to create a collective voice and influence for general practice as a provider.  My question now is to consider what role PCNs should play in this collective action?

Should the voice of general practice in an area be channelled through the PCNs and the PCN Clinical Directors?  After all, it is the PCNs that the system wants to talk to.

Right now PCNs and PCN Clinical Directors should form part of any collective general practice voice, particularly as the Clinical Directors all come from general practice at present.  But in future the Clinical Directors of the Integrated Neighbourhood Teams may not come from general practice.  Some may come from the community trust, the acute trust, or the council.

Meanwhile general practice needs to create its own provider voice in the system, particularly as its commissioning voice is being lost.  But it needs to build this as the voice of the GP practices at its heart.  It needs to do this in a way that means it can both harness the resources for general practice that come via PCNs, but also when general practice in future has to negotiate its role within the Integrated Neighbourhood Teams it can do so because there is a clear enough separation between what is local general practice and what are the activities of these new multi-agency teams.

This means the local general practice leadership voice cannot be solely that of the PCN Clinical Directors.  The LMC and any local GP provider must also be involved, and there must be a way of ensuring that there is route for voicing the needs of practices, and negotiating on their behalf, that is separate from the needs of PCNs.

While this nuance is difficult, I think ultimately it will largely come down to leadership.  If local GP leaders can work together for the good of the practices and their populations, regardless of the role that they are in, then they can create a strong leadership voice that they can iterate with the changing environment.