Many PCNs are finding the proximity to the end of March when the PCN DES comes to end a real challenge.  Practices are disengaging from the PCN because of the uncertainty as to what is coming next, and it is difficult for PCN leaders to coral the practices into any form of collective action.  Given this situation is a period of limbo inevitable, or can a more productive use of the time remaining be found?

Well the reality is that we are not surrounded only by uncertainty.  There are some things that we do know.  We know that next year there will be a one year “stepping stone” contract, in which we will see a continuation of PCNs more or less as they are, along with some “pointers” as to what may be to come.  There will be an election next year, and so any major changes will not happen until after a new government is in place.

We know that the funding for the ARRS roles will continue.  While we do not know exactly the form that this will take, given that PCNs are to continue then most likely is that the ARRS funding will also continue more or less as is.

We know that there is not going to be any backtracking on the funding for general practice that comes through PCNs.  At present over 25% of funding comes via PCNs, and because the system’s number one goal is to “integrate” general practice with the rest of the system then it is not going to revert from 1250 units (PCNs) to 7000 units (practices).  It simply is not going to happen. We also know financial pressure on individual practices will continue, and there will not suddenly be more GPs.

We know that what is coming next is going to be some version of PCNs working more closely with the other health and social care providers in the local neighbourhoods.  The original PCN DES back in 2019 said that the DES would be “amended from 20/21 to include collaboration with non-GP providers as a requirement”.  While this never happened because of Covid, the Fuller report (now de facto national primary care policy) has outlined exactly this in its description of Integrated Neighbourhood Teams, and it has become clear since that PCNs will operate as the general practice part of these teams rather than become them.

We are also aware of a couple of reasonably significant risks for general practice.  There is pressure in the system for more general practice resource to be controlled locally rather than nationally.  It is also likely that systems will seek to access PCN resources for the sole purpose of neighbourhood working, disregarding their additional function of supporting core general practice.  Both represent significant risks if general practice is not able to influence effectively in local systems.

Given we know all these things there are two actions that are sensible.  The first is for PCNs to create their own plan to manage the end of the PCN DES.  This would include getting the relationships between the practices to a place where the opportunity of the PCN can best be maximised by all (see last week’s blog), and freeing up some of the PCN leadership time to both start the process of building relationships with local providers and to engage in work to strengthen the voice of general practice within the local system.

The second is to refresh the vision for the PCN (if there is one).  I have written previously about this, but essentially unless the practices in the PCN have their own vision for what they want the PCN to achieve then the system is highly likely to impose is its own priorities for the PCN.  With the system changes around integrated care and integrated neighbourhood teams this is more of a risk than ever, so it is critical that practices are clear on the direction they want to take together so that they can shape any future changes into this direction, rather than allowing these changes to determine where they are going.

Working together to create a plan that focusses on those things that you can control and on mitigating the biggest risks is extremely empowering.  It is a much better way of dealing with the uncertainty than taking no action and waiting for a new direction to be imposed, and is one that is much more likely to achieve a better result for both the PCN and its practices.