The NHS announced last week that  they would be undertaking a review of primary care networks and how they will “work with partners across newly formed integrated care systems to meet the health needs of people in their local areas”.  The review will report by March 2022, ahead of ICSs going live as statutory bodies.  Whilst it might all appear very anodyne on the surface, it does set alarm bells ringing.

There are three reasons for concern.

1. The perceived need for greater national direction

What the announcement of the review signals is that NHS England, in what is now customary NHS England style, is seeking greater control over PCNs and how they operate.  The initial language used around PCNs was that they how they operated was for local determination by local practices to best meet the needs of local communities.

That, however, now appears to be going out of the window.  NHS England clearly wants to set more guidance and rules on PCNs and how they work.  The contractual constraints of PCNs are already suffocating for many, and so it is hard to see how extra national directions will be helpful.

What we have with this review is a signal that someone somewhere high up is not happy with how PCNs are progressing, and has put this review in place to change where they are headed.  This review has also been announced hot on the heels of the BMA motion for industrial action and mass resignations from PCNs.  This may be unrelated, but it does lead on to my second concern.

2. It signals a shift in ownership of PCNs away from practices

If you read the announcement from NHS England you will notice it has a very clear focus on joint working.  It talks about how PCNs “will work with partners”, how they can “drive more integrated primary, community and social care services at a local level”, how they can “bring partners together at a local level” etc etc (it carries on like this throughout).

If you recall when PCNs were first announced there was quite a number of references made to how PCN Boards would be expanded over time to be more than simply the member practices.  Whilst some PCNs have widened their PCN Board membership, most have not.  Given the language in this announcement it would be astonishing if the recommendations made were not about a shift of PCN ownership away from practices and towards a much wider ownership.

How far-fetched is it to suggest that this report will end up “recommending” a place for councils, community trusts (and no doubt others) on PCN Boards? Maybe a direct accountability into place-based partnerships will be imposed on them.  Whatever comes, it is hard to envisage a positive outcome of this review for practices.

3. It further widens the gap between PCNs and the sustainability of general practice

At a critical point in time, just over half way through the 5 year GP contract that introduced PCNs, when general practice has reached such a desperate place that it is prepared to consider strike action, this review is announced.  In the announcement general practice or GP practices receive only one mention, and that is about the need to improve partnership working between GP practices and other organisations.

This report will not be looking at how PCNs can better support the sustainability of GP practices, despite the majority of the additional funding for general practice coming via PCNs.  It is hard not to see the announcement of this report as part of NHS England’s response to the GPC’s threat of industrial action, and if it is it spells more bad news for general practice.

I am not generally a pessimist or a conspiracy theorist, but everything about this report sets alarm bells ringing.  Time will tell whether these are unfounded concerns, or whether it is the first signal of yet more challenges to come for general practice.