What is a network?  According to that modern day fount of all knowledge, Wikipedia, it is, “a set of human contacts known to an individual, with whom that individual would expect to interact at intervals to support a given set of activities. In other words, a personal network is a group of caring, dedicated people who are committed to maintain a relationship with a person in order to support a given set of activities.”

The key point here is that networks are based primarily on relationships.  So while Primary Care Networks (PCNs) may have originated through a contractual route, that shouldn’t be what defines them.  Rather the connectivity, interactions and mutual support of relationships are their lifeblood, and what will determine the impact they can have.

So far Primary Care Networks have, in the majority of cases, been made up of groups of GP practices.  Practices within a network have been building the relationships between themselves to build trust and enable joint working across practices.

But in the Network Contract DES Specification for 2019/20 it said, “There is no requirement for the Network Agreement that is signed by 30^th June 2019 to include collaboration between practices and other providers, but this will need to be developed over 2019/20 and to be well developed by the beginning of 2020/21 when the Network Agreement will need to be updated to reflect the new Network Contract DES Specification.” (p11, 3.6).

If we leave the cloud having over next year’s Network Contract DES specification aside for a moment, then the logic of this requirement is sound.  If PCNs are based on relationships, then to make the maximum impact they need to include all those who can contribute to the cause.

But of course there is another way of looking at this.  The reason why practices were uncomfortable signing the network agreement in the first place was the potential impact on the practice’s autonomy.  Practices didn’t want to be told how they would have to operate by the other members of the PCN.  But at least all the other members of the PCN were GP practices, and so there was a level of shared interest.  Widening the membership to include non-GP practice organisations reduces practice autonomy further (less influence on PCN decision making), with less certainty that decisions made will be made in the best interest of my particular practice.

So there are two factors at play here: impact and trust.  For PCNs to have the maximum impact they need a broader set of relationships.  But without trust practices are going to be reluctant to include new members into the PCN family.

Networks must start with a common purpose (clarity on what we are trying to achieve).  Identifying who can help deliver this purpose and widening the membership to include them is the way to move forward.  Let the shared purpose determine the terms of any agreements that need to be made, but prioritise person to person relationships, because it is only when we trust each other that we can work effectively together to make change happen.

The mistake is going to be starting with the network agreements, ahead of building relationships and trust.

PCNs have the opportunity to establish a new way of working for the NHS.  Instead of the traditional top down, bureaucracy heavy, organisation centric way of working, PCNs can model a new style based on trust, relationships and commitment to a common cause.  Whatever the PCN DES specification ends up saying for next year about extending the membership, how PCNs extend their membership is going to be at least as important as who with.