2024 is going to be a challenging one for PCNs.  The 5 year contract completes at the end of March next year, and while we know PCNs are to continue the pressure upon them is likely to be greater than ever.  Making sure the relationships they have in place now are where they need to be should be a priority for the coming months.  Here are 5 key relationships for PCNs to review.

1. PCNs and their member practices

Over a quarter of all resources coming in to general practice now come via PCNs.  With all the wage and inflationary cost pressures the future of practices depends on PCNs more than at any point previously, and as we move forward this will become more not less important.  As a result, relationships can go two ways.  Either practices can start fighting with each other and the PCN leadership in a desperate bid to secure the resources they need, or practices can work together and attempt to make the most of the opportunity the PCN presents.

Practices within a PCN can ill afford to be at each other’s throats.  PCNs will increasingly have to take on the role of representing their practices in system discussions.  Rightly or wrongly, more and more the system is looking to PCNs as the unit of general practice that it wants to deal with.  Obtaining the best possible outcomes will require the practices within each PCN to be working together.

2. PCNs and their local federation

I understand that not every area has a federation in place, but for those who do they could be a really important asset in the coming years.  The Fuller Report has pointed to the infrastructure underpinning PCNs and Integrated Neighbourhood Teams needing to be scaled up to be of the quality required in terms of HR, estates, finance and technology.  The local federation could be the provider of this infrastructure and the enabler of general practice controlling its own destiny.

The alternative is that the support for the PCN will be provided in future by one of the local NHS trusts.  With what I would euphemistically call “structural integration solutions” being very much on the agenda for general practice at the moment (i.e. making practices part of NHS trusts), then this would be a very risky road to travel down for those committed to a future for independent general practice.

3. PCNs and the other local PCNs

It is hard enough for the practices in a PCN to all get along, never mind all the PCNs in a local area!  But the reality is that moves are afoot to shift more and more decision making about general practice, and potentially resources, from a national to a local level.  When this happens general practice in a local area needs to have influence and be able to speak with a united voice to ensure that any deals that are made locally serve the best interests of the practices and their patients.

But this requires PCNs to be able to work effectively with each other.  There need to be trusting relationships in place, an ability to represent each other in system discussions, and a way of making decisions together.  This takes time, and so time is running out to get this to where it needs to be.

4. PCNs and the local system primary care group

System primary care groups are odd creations.  In many places they have been formed by the system rather than by general practice, the agendas are set by the system teams, and the membership is generally appointed rather than representative.  Yet the likelihood is that these groups will be the place where decisions about general practice  are made, which could have huge resource, workload and strategic implications for PCNs and practices in future.  Now is the time for PCNs to review whether these groups are working, whether their voice is really being heard, and to push for changes so that these groups are fit for purpose moving forward.

5. PCNs and local community providers

For the last 18 months the spectre of integrated neighbourhood teams has loomed over PCNs, with the Fuller report saying that these are what PCNs would ‘evolve’ into.  But more and more it is becoming clear that PCNs will be the general practice partner within these new teams, rather than them being a new future for PCNs themselves.  That said, the system focus remains very heavily on bringing primary and community care closer together, and so PCNs getting on the front foot in building these relationships will put them in the best possible place as these new teams develop.