Is a network of primary care networks (PCNs) a good idea?  What are the benefits, and why is operating a network of PCNs more difficult than it might at first appear?

It is only a couple of months ago that practices divided themselves into groupings along PCN lines, and the scars in some areas are not yet fully healed.  So it is with understandable trepidation that some PCN Clinical Directors are thinking about whether operating as part of a network of PCNs is something they really want to be part of.

The rationale for PCNs to work together is fairly solid.  There are (at least) four good reasons to do it.  First is simply for support.  PCNs are new entities, and many Clinical Directors (CDs) are new to such a leadership position.  By working closely with other PCN CDs, they can make sure they understand what is required of them, how (and whether) to meet the various asks the system is putting on them, and can share intelligence as to how to meet the different PCN requirements.  There is a safety and security in numbers, and operating together reduces the risk of your PCN becoming isolated, of making unintentional errors, or of being singled out by the system.

Second, working together as network of PCNs creates a greater capacity to meet the ever-growing demands the system is placing on this new cadre of leaders.  If one PCN CD can attend a meeting instead of five, the collective group of PCN CDs is better able to manage the workload between them, and protect precious time for building relationships between practices within the PCN.

Third, the collective voice of all the PCNs in an area speaking together is much more powerful than that of any individual PCN.  Indeed, if one PCN says one thing and then is directly contradicted by another, the overall voice of local general practice is weakened and the potential influence of the new PCNs hugely reduced.  But if a network of PCNs can agree a position, it can be hugely influential on the CCG and wider system.

Finally, the level of resources provided to PCNs is small compared to the asks that are being made of them.  By sharing resources, e.g. administration, finance, recruitment, training, HR (etc), the PCN pound will stretch much further, and the benefit to practices and ability to deliver significantly increased.

If the benefits are so clear why, then, is not every PCN already operating within a network of PCNs?  Indeed, why is it that in some places where such alliances across localities previously existed, they have they fallen by the wayside with the advent of PCNs as more formal entities?

Essentially, it is a question of trust.  For example:

• Do I trust the other PCN CD to speak on my behalf and adequately represent my PCN?
• Do I trust the other PCN CD not to take advantage of any opportunities for their own PCN, before sharing any relevant information with me?
• Do I trust that the decisions the other PCN CDs will make are the best ones for practices? Or that if I make a decision that is worse for my PCN but better for the wider group, when the scenario is reversed the other PCN CDs will equally make the same decision?
• Do my practices trust me to make the right decisions when it comes to the other PCNs? Will they back me if I choose for us to be represented by a different PCN CD? Isn’t it safer to make sure I represent my practices directly?
• Do I trust that I am getting a fair share of resources that are shared?

With sharing comes a loss of control.  Giving up control in this way requires trust.  The benefits of PCNs working together in a network of networks may be obvious, but without trust it is very difficult for them to be realised.