It is a difficult time for general practice right now. The pressures of workforce and workload are higher than ever, exacerbated by the media and their impact on patient expectations and overall morale.  How can general practice move forward?  How can it shift from the place that it is now into a more sustainable future?

In 2016 the GP Forward View, a 5 year “rescue package” for general practice, announced an extra £2.4bn for general practice by 2021.  This was then somewhat usurped in 2019 with the new 5 year GP contract that announced an additional £2.8bn for general practice by 2024.

What we have known for a while is that more resources on its own are never going to be enough for general practice.  We don’t feel £2.4bn better off than five years ago.  The reason for this is the growth in resources will never be able to keep up with the growth in patient demand and expectations.  There need to be changes alongside the resources.  These changes need to be in how we manage demand and how we organise ourselves.

Here we get into problems.  No one really likes change.  Look at how certain sections of the public and the media have reacted to changes to the management of demand in general practice where only those who actually need to be seen (as opposed to those who want to be) are seen face to face.  Whether the government likes it or not we will end up there, but it helpfully reinforces the point that no one likes change.

When you examine what options are available for changes in terms of how general practice organises itself (which we did in our 2016 book) they are broadly around staffing, operating at scale, using technology and working in partnership with other organisations.

This is where PCNs come in.  What stands out for me about PCNs is that they offer an opportunity for practices to be able to make virtually all of these changes, and to be able to do so in a way that protects the independent contractor model.  Prior to PCNs it was all about mergers and super practices, but what PCNs do is provide a construct that allows practices to access the benefits of scale while at the same time protecting their own individual identities.

But delivering the potential benefits does not happen by itself, or as a function of signing up to the PCN DES.  It requires practices within a PCN to commit to using the PCN construct to drive change in the way the practices operate to realise the benefits.  Change does not become easy because you call it a PCN.  It remains difficult, but what PCNs provide is a framework for practices to use if they choose to do so (in addition to providing a huge source of resources – £1.8bn of the additional £2.8bn announced in 2019 is coming via PCNs).

I have no idea whether this was the original idea behind PCNs.  I suspect it wasn’t.  Certainly the contractual nature of PCNs, the tick box style of the IIF, the push to recruit more and more new roles with hardly any support for transformation alongside these roles, and the continual attempts by the system to hijack the PCN agenda are not conducive to practice transformation.  But at their core PCNs do provide practices with the chance to broaden their staffing model to reduce the pressure on the GPs and to build relationships with other practices and other organisations to create shared service models that work better for everyone.

However, at present it feels like PCNs are an opportunity for general practice that is not really being grasped.  Many practices choose to keep PCNs at arm’s length.  The BMA is trying to use PCNs as a mechanism for pressuring government and NHSE.  Others want to use PCNs for their own ends.  But PCNs are a huge, well-resourced opportunity to make change that can be a huge force for good and for creating a positive future for practices.  Practices just need to choose to take it.