We have a problem in general practice.  The system wants to work with units of general practice that are PCN-sized.  Practices, however, are (in the main) not PCN-sized and have no intention of becoming so.  The system is carrying on regardless.  What does this mean for practices?

Dr Steve Taylor recently posted on X that while the global sum for GP practices stands at £104 per person, PCN funding is now at £38 per person.  So over a quarter of all the funding coming into general practice now comes via PCNs.  The system’s desire to work through PCN-sized units of general practice means that the amount of funding coming through PCNs is going to continue to rise.

If we know that this is how things will develop in the future (regardless of the rights and wrongs of the policy), what is the most sensible way for practices to respond?

An increasingly common response is for practices to focus on ensuring that the practice receives its share of the funding that comes into the PCN.  The practice has no real interest in the collective of practices that is the PCN or its joint work, but does everything it can to ensure as much resource as possible is directed to individual practice level.

For PCN Clinical Directors this can be hugely frustrating.  They constantly feel like they are having to battle to ensure the PCN is able to fulfil its requirements alongside meeting these requests from practices.   The PCN and the practices end up feeling like they are disconnected and are frequently at odds with each other.

This scenario has lost sight of one really important fact.  The only people who are supporting general practice right now is general practice itself.

There is no other support available.  The system has become distant, remote, and preoccupied with access and system working.  There is the CQC with its new practice inspection framework, alongside a system that has introduced legislative changes to force practices to work differently.  Noone else is on the side of practices.

The most accessible form of support is actually from the other practices in the PCN, alongside the PCN itself (and local federation if there is one).  The opportunity exists to learn from and support each other.

The problem with the “give everything to the practices” approach to PCNs is that it misses this opportunity for support.  Instead, it deepens the historic sense of divide between practices and entrenches the barriers around each practice, despite the challenges that nearly all practices are facing.

To maximise the value of the total of the funds coming into general practice, both now and in the future, practices in the PCN should consider what is best done individually at the level of the practice, and what is best done collectively at PCN level.  Regardless of what some might say, there is value in some things been done once across the group of practices in a PCN.  Equally some things need to be done at individual practice level.  Even then, there is value in each practice taking the time to learn from the other practices on how actions at a practice level are carried out, and in supporting each other to ensure the best systems and processes are in place at each practice.

The PCN has a key role in enabling this.  The current focus on access is a perfect example.  The role of the PCN is not to put together a PCN plan that the system will sign off on, and leave the practices to work on their own to meet the new access requirements.  Instead, it is to ensure that the best balance of PCN provision and practice provision is agreed and put in place, and that practices are given the opportunity to share and learn from each other so that they are each equipped as best they can be to meet the new requirements.  Practices can and should be supporting each other because they are in this together.

PCNs can either be a barrier to practices receiving their share of the funding, or they can be an enabler of efficiency, innovation and support.  Practices are not in competition with each other, and treating PCNs as a practice competition for resources will ultimately mean that all the practices in the PCN suffer as a result.  For practices to survive in this new world of integrated care systems, they must work together and support each other wherever and whenever they can, and it is the PCN that creates the opportunity for this to happen.