The NHS is undergoing some significant changes right now, and the implications for general practice are potentially hugely significant.  Could it be that whoever ends up providing the support that PCNs need in fact ends up being the organisation that controls general practice?

PCNs are the place to where all the additional resource into general practice is being channelled.  This is the crux of five year deal agreed in 2019, and when the GPC tried to renegotiate this this year, and put more into the core contract, they were met with short shrift.  Instead the message was very much that PCNs are here to stay.

The priority for the NHS with the shift to Integrated Care Systems (ICSs) is for general practice to be able to act as a “partner” in the system.  What this means is that in any individual “place” area they want one way of contacting and doing business with general practice (instead of c50  if there are for example 40 practices, 7 PCNs, 2 federations and an LMC).

It is not a huge leap to think that not only will any additional resource for general practice continue to be channelled through PCNs, but also that ICSs will shift all additional, non-core GP funding through PCNs.  Indeed it would not be a huge surprise if all the PCN funding shifted at the end of the 5 year contract from national terms to local ICS-based terms, to allow “effective local tailoring of the resource to local needs”.

PCNs, therefore, will continue to grow, and potentially take on a increasing role in relation to access and quality across all of its member practices.  PCNs already need far more of an infrastructure than they have (think training, HR, finance, governance, performance etc), and this need only becomes more pressing with further growth and investment.  There also needs to be a bringing together of the PCNs within any place area, to make it workable for the system as a whole.

Where does this infrastructure come from?  One of the other provider organisations in the ICS is the most obvious solution.  Such an integration sorts out the infrastructure issue, as general practice and PCNs can simply tap into the already existing quality, estates, HR (etc) functions within that organisation.

While this might feel like too big of a leap, our Secretary of State seems to have already nailed his colours firmly to the mast with his support for the recent think tank paper extolling the virtues of the vertical integration of general practice and its assimilation into acute trusts.  ICSs want to be able to do business with general practice, and this will be far easier if it is all sitting within an existing organisation with a Board and Chief Executive and clear lines of accountability.  For the other provider organisations within an ICS, one of them taking this on seems a far more attractive option than anything else, if for no other reason than it limits the number of providers around the ICS table.

The alternative is that general practice takes this on and organises itself.  The GP organisations in an area can choose to come together and create a single leadership team, and bring the LMC, federation and PCN leaders all into one group.  This group can start to operate as the leadership team for local general practice.  They can build on any existing infrastructure they have, such as that within their local federation, and work with the CCG primary care team to take on more of the resources that are currently sitting there.

I am not underestimating how difficult a task this is, but there are places up and down the country who are starting to work this through and put it into place.

Nobody else will want this.  It is easier for them to work with the existing provider organisations.  For them, waiting for the inevitable requirement for someone else to need to take this on is the easiest option.  While it might feel like a big change for general practice to make, it might also be the only opportunity general practice has to secure its independence into the future.