The requirements imposed on practices by PCNs can feel cumbersome and unmanageable.  It is already difficult for practices to cope with all the demands of the core contract, without having the extra demands of the PCN to contend with.  But is there an opportunity in PCNs that many practices are missing?

Most practices have grappled with the question of what is the right size for the practice.  The average practice list size now stands at over 8,500 patients, and there are about 6,500 GP practices.  Over time, the list size is getting larger and the total number of practices is falling.  The financial, workforce and workload challenges faced by individual practices pushes them to need to operate in bigger units to ensure a critical size of workforce is in place and to manage costs effectively.

As a result, many practices consider merger.  Mergers (in theory) allow a larger, more flexible workforce, a stronger and more resilient leadership team, and the opportunity to create back office economies of scale as well as efficiencies in how services are delivered.

But the reality with mergers is that simply merging on its own does not create these benefits.  Delivery of these benefits requires considerable hard work beyond the challenge of merging in the first place.  Indeed, there are many merged practices where not only have none of these benefits been realised, but there is now also an additional tension (and sometimes open hostility) between the two sides that merged which makes the day to day experience of working much more unpleasant than it was previously.

As a result there are many practices with list sizes of well under 10,000 that will not countenance the idea of merger, and will (rightly) point to the strong, cohesive culture they have in their practice and the fantastic results this generates both in experience and outcomes for their patients.

The question, then, is whether there is another way for practices to experience the benefits of operating at greater scale, without having to take the often irreversible step of merging?

This is where PCNs (potentially!) come in.  Could we consider PCNs not as a contractually-imposed burden that redirects both time and resources away from the core contract, but rather as an opportunity to work at-scale with our surrounding practices and explore how the benefits of joint working can be realised free from the legal tethers of merger while at the same time maintaining our individual practice identities?

Prior to PCNs there was no such option available.  But PCNs have a leadership resource, an additional staffing budget, and additional income generating opportunities all in one place.  The PCN construct allows practices to work together and share the potential benefits within a light touch governance framework, and with (crucially) the ability for each practice to maintain its own practice culture and way of working.

The opportunity existing does not mean it is easy to take (as evidenced by the lived experience of many PCNs across the country).  The need to develop trust and build a willingness to cede individual decision making on certain issues is required for a merger to succeed, and this is equally the case in PCNs.  The investment in relationships that successful mergers require is not negated by the maintenance of practice boundaries within a PCN.  PCNs increase in effectiveness as the level of trust grows.

The environment that GP practices are in is tough and it is not going to become more supportive of individual practices any time soon.  There is still at least 9 months of PCNs to go, and most likely another 12 months on top of that, and so now may be the last chance for practices to start working together to make the most of the opportunity that these unique constructs present.