As the direction of travel looks more and more like it is PCN-shaped and geared towards general practice at bigger scale, should practices within a PCN be considering whether remaining as separate entities is really the best course of action?

There are some heavy hints in the Delivery Plan for Recovering Access to Primary Care document that whatever comes next will be a further push to at-scale working in general practice, in particular the rather unambiguous, “Integrating primary care requires general practice to operate at a larger scale either as part of PCNs or at place level” (p41).

Whatever comes next, don’t expect it to be an end to PCNs and a reversion to receiving funding directly at a practice level.  What is clear is that the wider NHS integrated care agenda is seeking to create bigger, more partnership-friendly units of general practice, and this is not going to change simply because PCNs are not hugely popular with core general practice.

We don’t know the detail of what is coming next.  I don’t think anybody does, even NHS England.  But I do think there are some principles that we can be relatively sure of, and these are that whatever changes are agreed (or imposed) they will be supporting at-scale general practice, more local commissioning of general practice (i.e. less via the national contract), and enabling easier partnerships between general practice and other local providers.

What can practices do now?  Is there anything, because the uncertainty as to what is coming next can be stifling, and indeed for many is creating a reluctance to take any action at all.

I think this is a mistake.  What we have is 10 months of certainty, as we know exactly what is in this year’s contract.  By now we know what we are doing with PCNs (by and large), and so there is almost a sense of this year being the calm before the (next) storm. To me this represents the perfect opportunity to make any big or strategic changes that the practice is considering.

What would these changes be?  Well, the most obvious change is for practices within a PCN to merge and become a single practice.  At present the PCN funding, and ARRS staffing, is separate from practice funding and staffing.  Except it is not in those practices that are single practice PCNs.  In those practices what happens is the PCN requirements simply become another part of the practice’s contractual requirements, and the practice is able to use all of the resources (funding and staffing) as flexibly as it wishes to meet the totality of the requirements.

You can listen in to the Swan practice/PCN explaining how it works for them as a single practice PCN here.  It was no accident that the case study used on p41 of the Access Recovery Plan discussing the future of general practice is that of the Foundry – another single practice PCN.

While I understand the challenges that merging practices creates, and the resistance that many GPs have to the loss of individual autonomy that comes with it, I am not convinced that practices can continue to be sustainable whilst PCN funding and core practice funding remain separate.  Bringing the two together feels like a smart move because of how it enables a longer term sustainability for the practice.  It certainly seems preferable to that funding (PCN, or whatever its successor is) being held by an NHS provider, and the practice constantly having to fight to access it (which seems like one of the alternatives being considered).

It is true we do not know what the future holds, and so there is always an element of risk.  But doing nothing also contains risks, and given that we know the funding flow is much more likely to be PCN-shaped than practice-shaped, making our practices PCN-shaped while we still have the chance feels like an option we should be giving much more time to considering.