There is a lot of hate for PCNs at the moment.  Not least the BMA which has just produced its “call to action for general practice” (essentially its wish list for the new contract) and in which it says, “Because it has proven to be a failed project that results in a postcode lottery for patients and patchy staff recruitment for providers, abolish the PCN DES and move all funding and resources into core GMS”.

This is pretty harsh, not least for the thousands of GPs who have worked over the last 5 years in Clinical Director or leadership roles to make PCNs a success.  And (whatever the BMA says) PCNs have not been all bad.  The problem has been an underinvestment in core general practice, not anything that PCNs have or have not done.

The struggles of general practice pre-date PCNs.  Back in 2016, as many of you will recall, the government of the day produced the GP Forward View, which sought to address the challenges general practice was facing.  At the same time I reviewed the options available to practices to create a sustainable future.  Long story short, the main things practices could do was work at scale, introduce new roles, and build partnerships with other organisations in the health care system.

The interesting thing about PCNs is that they provide the opportunity for practices to do each of these things.  They create an infrastructure for practices to work together and achieve the benefits of scale without having to merge, they provide a (fully funded) route into introducing new roles, and they enable a wider set of supportive partnerships with other healthcare organisations to be built that would be much more difficult at the level of the individual practice.

So while I understand the challenges of practices with different cultures working together, and the frustration that all the investment for general practice not coming directly causes, that does not mean that PCNs are all bad, or that there are not opportunities for core general practice within them.

Right now there is precious little support available for practices.  A new contractual requirement has been imposed to respond to patient contacts to the practice on the same day.  Whilst maybe we shouldn’t expect support from the government or NHS England, they simply announced the change on the day it was made driving a slew of calls to practices from patients demanding their “right” to be seen that day be upheld.

The BMA’s response has been to push their safe working guide for general practice.  This is essentially a call for practices to do the contractual equivalent of work to rule as a response to the imposition of the contract changes.  It includes limits such as a maximum of 25 patient contacts per day and 15 minute appointments, with the unmet demand being either referred to 111, A&E or placed on a waiting list.  For many practices deprioritising the needs of their patients in this way is not something they are prepared to do.

The relatively newly formed Integrated Care Boards remain in flux and the majority are able to provide precious little support to practices.  They push the access agenda locally but when it comes to offering tangible support very little has been forthcoming.

All of which (somewhat ironically) means that for most practices right now the major and most fruitful source of practical support is their own PCN.  The best source of support for general practice is general practice, and PCNs provide a simple (and resourced) framework that enables this.  Across PCNs practices can share learning, experiences, ways of working and even, through the ever increasing ARRS teams, staff.  They can access resources to make changes.  They can build shared infrastructure where it can make a difference to local practice delivery.  They can free up leadership time to provide support where it is most needed.

At a time when general practice is under such significant pressure it is not helpful for the service to turn on itself.  PCNs are not the enemy of general practice.  The partnership model seems unlikely to be able to continue on its own, and if PCNs are not in place to support it then the alternatives look a whole lot worse.