Here is a question to consider: will GP practices be more resilient if they focus internally and on core services only, or if they invest time in collaborating with others?  The implications of the response are significant, but the answer is not as straightforward as it may seem.

The natural response when under pressure is to focus internally.  There is a limited amount of organisational resource, and so by prioritising the use of this internally it maximises the impact it has upon the practice where it is needed.  Ensuring internal operational efficiency and making the most of the available resources by focussing them on the core business are sensible responses in times of pressure.

This is part of the rationale for the collective action across general practice.  The service has been underfunded for the third consecutive year, and so the response to focus only on those things that are funded and deliver only those in order to remain viable moving forward (alongside building pressure for more resources) is logical.

However, resilience can also come from collaboration.  In the first instance this can come from collaboration with other practices in the PCN.  Where practices in a PCN are working to support each other, the benefits can extend far beyond those of access to the shared PCN staff and resources.

I was talking to a PCN recently where a practice shared how their computer system had gone down and a neighbouring practice from within their PCN had stepped in to support them so that they were still able to access their patient records.  This would not have happened pre-PCN.

In the same PCN the practices had recognised the resilience challenges turnover of practice managers causes, and as a result have implemented a practice manager mentoring scheme, whereby any new practice managers entering the PCN are allocated a practice manager mentor from another practice who dedicates time to support them as they get to grips with their new role.

The scale of most practices makes them very vulnerable when events such as IT failures and practice manager departures occur, but they can be much more resilient when collaborating effectively with other local practices.  This does not happen automatically as a result of working within a PCN, but resilience benefits such as these exist when the practices within the PCN collaborate effectively.

The business environment that GP practices operate in is also changing.  Previously the GP contract on its own enabled practices to thrive, but now the world has changed.  We already have huge amounts of GP income tied up in PCNs, and the new government’s focus on neighbourhoods means that even though there may be some shoring up of the core contract it is never going to revert to how it was.  Instead, more and more GP funding is going to be tied up in neighbourhood working, i.e. a scaling up of PCNs to include a much wider range of stakeholders.

This means that future income will be dependent on relationships not just with other practices, but with a wider group of local providers.  Effective collaboration with these providers will be key to both accessing this and making the most of potential future opportunities and funding.

So while an internal focus may bring some short term stability, if it is done at the cost of developing productive external relationships it may ultimately end up being damaging.  Longer term resilience will be much more likely to come from collaboration, because this is where both effective support and future funding opportunities are most likely to lie.