Roughly 20% of the total resource for general practice is tied up in PCNs.  But are practices making the most of this resource?  And is the need for equity across practices preventing this opportunity from really being taken?

Practice finances are tight across the country this year as a result of the third consecutive imposed contract by NHS England.  With so much of the resource (£2.5billion+) for general practice now tied up in PCNs, practices have no choice but to find ways of accessing it.

Interestingly, the PCN DES now defines one of the core functions of the PCN as, “To coordinate, organise and deploy shared resources to support and improve resilience and care delivery at both PCN and practice level. (This could also include the PCN delivering practice-level contractual requirements such as vaccinations, screening and health checks, provision of personally administered items, QOF and IIF-related activity during core hours).”

So the contract is actually encouraging practices to consider how the PCN can support individual practice resilience.  But the reality is that there are not many PCNs where the PCN (or a practice within the PCN) is carrying out core practice activity on behalf of other practices.

There are a number of reasons for this.  The first is that for most practices the independence of the practice is sacrosanct, and that includes from the PCN.  So while the practice may be prepared to participate in joint PCN ventures, it is quite another thing to give up some of the core practice activity so that it can be provided by the PCN.

This is one of the reasons why there is so much resistance to the attempted imposition by some ICBs of mandatory same day access hubs at a PCN level.  Most practices regard delivering on the day urgent care to their patients as a core part of what they do, and they are not prepared to give this up  to the PCN.

So if a PCN is going to get into some of the core practice activities suggested by the PCN DES then the first thing it will have to do is overcome the innate resistance that exists to this from member practices.  Practices will need to believe that the PCN is not taking away the things that make up the core practice identity, but instead is offering a new more efficient and effective mechanism by which these things can be carried out.  This is no easy challenge.

The second barrier that prevents provision at a PCN versus a practice level is the implicit belief that exists in nearly all PCNs that any split of resources or activity between practices needs to be equal.  If a PCN service is set up, it needs to be equally available to the patients of each practice.  Where PCN staff are employed, each practice needs to receive their fair share of time of clinician time or appointments.

But practices do not have an equal need for the same staff.  They don’t have the same amount of space available.  They don’t have the same need for the PCN services that are provided.  They don’t have the same practice populations, or practice staffing profiles.  It doesn’t actually make sense then for all the PCN resources to be divided equally, if the goal is to ensure that they add the maximum amount of value.

So for example it may make sense for the PCN to set up a home visiting for 3 of the practices in a PCN, while the other two continue to do their own (if the two practices have a good system for visits in place, enjoy and want to continue doing them, but the other three are struggling with the capacity and time to carry these out).

But what happens is the need for the services to be “fair” overrides everything, and so the two practices who don’t need the service object and it never gets set up.  Rather than spending time working out what the different needs of those two practices are and how those could be met, instead the only things that get agreed are those where all practices can benefit. This is significantly limiting the benefits PCNs can bring to practices.

The financial situation facing general practice is such that practices may need to start being more flexible and creative in their thinking as to what the PCN do, if they are really to make the most of the resource that is tied up within them.