It is a difficult period for PCNs as all the talk is about neighbourhoods, while PCNs themselves are not getting much of a look in.  This in turn is serving to create question marks around the very future of PCNs and creating additional pressure for PCN leaders who are having to manage (yet another) period of uncertainty.

Given this situation, what is the best way for PCNs to prepare for neighbourhoods?

While neighbourhoods still remain largely in the realm of the conceptual, with very few being able to adequately define what they are or what their purpose is, it is easy for PCN leaders to adopt the ‘head in the sand’ approach and ignore them until something more concrete comes along.

But the government has been clear that the development of a ‘Neighbourhood Health Service’ is central to their plans, and there is no doubt that they are going to feature front and centre in the forthcoming 10 year plan (which is now expected in June).  Equally they have been clear that they want their development to be locally led, tailored to local needs, and not be a one size fits all top down imposition.

With this in mind, ignoring their development, and potentially missing out on local conversations as to how they will take shape, runs the risk of allowing others to mould them to their own needs and to diminish the influence of PCNs and practices.

There are two actions I would recommend PCNs take right now.  The first is to identify how they can free up as much of their PCN Clinical Director’s time as possible to build relationships and influence externally.

In the majority of PCNs the CD tends to focus on internal issues and relationships.  They work to maintain the goodwill of the member practices and ensure the delivery of services such as enhanced access and ARRS initiatives like home visiting.  But now CDs need to be freed up from this work by other clinical leads and managers in the PCNs so that they can focus externally.

Exactly how this can happen will vary greatly from PCN to PCN.  But the stage of development that PCNs need to reach is one that some have got to already where there is enough of a leadership infrastructure that means the whole PCN enterprise is not dependent on the CD.

CDs in turn need to focus their efforts on building relationships with other organisations and local leaders across the neighbourhood.  It is not a case of simply attending the ICB-driven meetings (although where they are making decisions about how the neighbourhoods are to develop locally these are important!), but more about building the personal relationships across the local provider network that will strengthen the influence of the PCN in local decision making.

The second action I would recommend is for local PCNs to work with each other, the local federation (if there is one) and the LMC to establish what the NHS Confederation term a primary care collaborative.

While it is not possible for one PCN or CD to do this on their own, it is possible to choose to invest time in building this joint forum for PCNs and practices that once in place can maximise the influence of general practice in the development of neighbourhoods.

Where these fora have developed, sometimes the impetus has come from the PCN CDs, sometimes from the federation, sometimes from the LMC and sometimes even the ICB.  Wherever the energy comes from for PCNs it is about getting behind this, recognising its importance in shaping how the neighbourhoods develop, and investing the time to make it succeed.

While the final shape of neighbourhoods remains outside the control of PCNs, the ability to influence this does not.  This development period that we are in now is the most important as it is when decisions are made that have lasting consequences, and so the immediate priority must be making the influence on these decisions by PCNs and practices as strong as possible.