Many PCNs are finding themselves increasingly hamstrung by the lack of certainty as to what is coming next.  We know the 5 years of the PCN DES comes to an end in March next year, and so the question that many have is whether it is worth investing time and effort into the PCN given the chance that things may all change again in a little over 9 months’ time.

Life for PCN Clinical Directors, managers and leaders is difficult enough, without having this additional uncertainty to contend with.  But how real is this uncertainty, and how likely is it that PCNs will be replaced by something new in just a few months’ time?

The first place to start is the wider NHS environment.  The NHS has entered the new world of Integrated Care Systems (ICSs).  It is fair to say that even those working in these new bodies are finding it hard to fully get their heads round what they are supposed to be doing, but the government’s response to the Hewitt report on ICSs suggests that they are going to remain the overall direction of travel for the NHS into the foreseeable future.

ICSs are premised on all of the different parts of the NHS system working together in partnership to improve the delivery of care for patients. General practice is one of these system parts.  Historically the system has found it impossible to partner with the 7000+ GP practices across the country, which was the main driver behind the introduction of what is now 1250 PCNs around neighbourhood areas.

Given the ongoing push for partnership working across the NHS, it therefore seems highly unlikely that there will be a rowing back from the joint working between practices that PCNs have created.  While this will undoubtedly be much to the disappointment of the many GPs and practices who dislike the requirement to work with other practices through PCNs, this unpopularity will not result in a national reversion to practices as the primary unit for the delivery of resources into general practice.

Instead what we will most likely see is a move to strengthen the joint working between practices across neighbourhood areas that has been developed over the last 5 years by PCNs.

The question is whether this will remain as PCNs per se, or whether these will be changed into something else.  The biggest clue we have as to that question is in the Fuller Report, which states that PCNs are to “evolve into” integrated neighbourhood teams.  It describes these in this way,

“This is usually most powerful in neighbourhoods of 30-50,000, where teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams, and domiciliary and care staff can work together to share resources and information and form multidisciplinary teams (MDTs) dedicated to improving the health and wellbeing of a local community and tackling health inequalities.” Fuller report p6.

The Fuller report was published over a year ago, and yet still now no one seems any the wiser as to what an integrated neighbourhood team actually is.  While many ICSs have groups looking at this, the timescale set in the report that these integrated neighbourhood teams would up and running in the “Core20PLUS5 most deprived areas by April 2023” has clearly been missed.

The key question appears to be whether an integrated neighbourhood team replaces the PCN, i.e. once there is an integrated neighbourhood team there is no longer a PCN, or whether the PCN represents the group of GP practices that are participating as a group in the local integrated neighbourhood team, which has a much wider group of participants than the PCN.  This latter option appears to be the one being adopted by those places that do claim already to have integrated neighbourhood teams (e.g. Suffolk).

So it would seem that the most likely outcome is that PCNs remain.  Even Labour’s health policy, despite all the noise they have made around nationalising general practice, is to create a “Neighbourhood Health Service”, which very much looks like it has PCNs at the centre.  In fact, given the current policy environment, it is hard right now to envision a future in which there is not something PCN-shaped that continues to be the conduit for the majority of additional resources coming into general practice.

While none of us know for sure what the future holds, it does seem a safe bet that NHS England and the government will want to build on the progress they have made through PCNs beyond March 2024.  There is a chance that the name will change (it is still the NHS after all), but it seem extremely unlikely that the scale of working will alter as there have been no pointers in any other direction.  The pressure for the PCN unit to build more effective partnerships with system partners will undoubtedly grow, but the core unit of the group of practices as a PCN seems destined to remain.

Given this, the most sensible course for practices right now is to continue to invest in the PCN, and ensure that the collection of practices that form the PCN are as solid and secure as possible so that they are as ready as they can be for whatever the evolution is that they will have to collectively face next year.