As this is my last blog of 2020 (we are going to give you a two week break from the podcast and blog over Christmas!), I thought I would share what I foresee on the horizon for PCNs next year.  I am of course aware that predictions are a mug’s game (who could have predicted how this year would turn out?), but I always find it helpful to think through what might be coming up ahead.

My main prediction for 2021 is that there will be a move towards smaller PCNs.

Normally in the NHS, we like to start small and then merge organisations into bigger and bigger entities.  Those with longer memories will recall that multiple Primary Care Groups became a smaller number of Primary Care Trusts (PCTs), and the number of CCGs has been on the decline ever since their inception.

I suspect, however, the trend will be different for PCNs.

Currently, there are around 1,250 PCNs, and the “average” PCN is very close to the originally-envisaged upper limit of 50,000.  This means approximately half of the PCNs have population sizes in excess of the 50,000.  Why might that be?  Why have GP practices chosen to group into larger groupings than were expected?

My hypothesis is that the primary reason for this was because PCNs looked like a lot of work right from the outset, and it seemed sensible to group together so that work could be shared out between more practices, and the burden of additional work on anyone practice would be minimised.  The problem is we are now at a point where the resources and funding coming through PCNs is significant, and far outweighs anything that is coming through the core GP contract.  The ARRS in many PCNs will be funding not much shy of a million pounds’ worth of extra roles, and the extended access funding is also likely to be pushing £0.5 million for many PCNs.

What practices want is to feel the benefit of these resources.  The challenge of working with lots of other practices is these resources can feel distant from the practice, there can be lots of different ideas as to how these resources should be deployed, and it can be hard for any individual practice to exert the control it would like to over PCN decisions.

While at first it was helpful for practices to be distant from PCN decision making and to some extent be protected from the additional work, now that the resources are becoming very real many practices are finding the set up frustrating.  Cue conversations between smaller groups of often like-minded practices about what they think should be happening, and wouldn’t it be better if they were their own PCN?

It is a logical step.  Smaller groups of practices in PCNs can have really detailed conversations about how the totality of the resource they now have (existing practice resources and the additional PCN resources) can be combined to deliver maximum benefit to the practices and their patients, and ensure that all of the PCN requirements are met.

The artificial divide between PCN business and practice business does not actually serve either of those businesses, but is necessary when there are multiple practices operating together with relatively low levels of trust.  This barrier is removed when the PCN becomes smaller and the number of practices who have to work together is reduced.

The other factor at play is that it is very difficult to introduce new roles into general practice across large numbers of practices.  Those in the new roles need a home, and to be linked primarily with one practice, and receive all the support that comes with that.  PCN working across multiple practices does not allow that, whereas smaller PCNs can.  We are going to see significant turnover in the new roles next year, and they are likely to settle with those PCNs who are able to look after them.

There it is – more and smaller PCNs next year.  Have a great Christmas, I hope you have a chance to take some well-earned rest, and thank you for all your support this year.