The biggest challenge the publication of the PCN DES specifications for next year has created is not so much the detail contained within the documents but the loss of enthusiasm amongst GPs for the whole PCN project.

Before Christmas there was hope that PCNs could mark a new dawn for general practice.  But that bubble was burst when the specifications demonstrated the lack of any national ambition to use PCNs to support the ailing profession.

Wherever the national negotiations end up, it is hard to believe they will restore the hope and energy that existed last year.  But PCNs don’t go from being a good thing to a bad thing overnight, and so it is worth taking some time to reflect on the opportunities PCNs create, regardless of national specifications.

A good place to start is the time before PCNs existed (remember that?).  There were two main trends in general practice, both a response to the pressures the service has been facing.  The first was the introduction of new roles, not to replace GPs but to manage those parts of the (growing) demand that their skills made them best placed to take on.  The second was the move to bigger practices and operating at scale, to develop the resilience of practices and to enable them to embrace any opportunities that develop.

PCNs continue both these trends.  The majority of the funding for PCNs is for the introduction of new roles, and PCNs bring practices together and provide the opportunity for the benefits of scale to be delivered across practices.

The big new opportunity the introduction of PCNs has created is working in partnership with other providers.  One of the rationales for PCNs was to enable the gap between primary care and the rest of the system to be closed, and to bring (in particular) general practice and community services closer together.

For GP practices PCNs create the opportunity to better meet the needs of the local population.  Practices can clarify what part of the local demand they are best placed to meet, and what part of the demand is best met by partners, by collaborations and by network wide services.  Where gaps in service provision exist PCNs can work with local partner organisations to fill these gaps.

In a world where we didn’t have PCNs what would general practice be doing?  Probably working towards the development of something that looks very much like PCNs…

So the problem is not primary care networks themselves.  PCNs enable general practice to respond effectively to the pressures they face and to better meet the demands they are under.  The issue lies with the PCN DES specifications which seem to be attempting to shift PCNs away from supporting general practice and into the generation of additional work that will make the current problems worse.

But that doesn’t make PCNs themselves a bad thing.  They remain the best hope for general practice for the future.  What has been revealed as the ‘bad thing’ is the level of control the national contract has over PCNs.  Leaving the destiny of PCNs in national hands already looks like a recipe for disaster.  So now may be a good time for practices and local systems to think carefully about exactly how they want to make PCNs work for them, and to exert more local control to restore the confidence of practices that PCNs can still be the path to a bright new future.