A gap has developed between CCGs and Primary Care Networks (PCNs).

It is not hard to understand why this has happened.  PCNs formed as a result of the national GP contract agreement, and not as a result of commissioning decisions by the local CCG.  Indeed, many CCGs had local primary care development plans in place involving “localities” that were somewhat derailed by the imposition of PCNs via the national contract. The core funding for PCNs comes through the national contract, and it is the national requirements of the PCN DES that practices that have signed up to meet.

Meanwhile local CCGs and STPs have incorporated PCNs within their overall system development plan.  For many, they are the centrepiece of the out-of-hospital plan for the new system.  PCNs in these plans go way beyond groups of practices, and include a whole range of NHS, community and voluntary sector organisations working together to transform care and outcomes for patients and local residents.

But, frequently, the system has not discussed these expectations with the nascent PCNs themselves.  It has not worked to get any agreement about the role that it would like PCNs to play in the future with the new PCN leaders.  Instead local systems seem to be relying on an assumption that because the national framework agreement exists, the PCNs will then function and develop in the way the local system wants them to.

And so we have a problem.  The expectations the local system has of PCNs (to play its role as defined by the local plan) is significantly different to the expectations local practices have of PCNs (to meet the requirements of the PCN DES).  Throw into the mix the issue of overall sustainability of general practice and where PCNs sit in relation to that (where nationally it is not clear let alone locally) then it is not hard to see why this gap between CCGs and PCNs has developed.

This manifests in lots of different ways.  Take the new roles.  There is a gap between the expectations and issues for practices about the introduction of the new roles through PCNs and those of the system.  Practices are concerned about making up the 30% shortfall in funding, about potential liability for the roles if the funding stops after five years, and whether the roles will create rather than reduce overall GP workload.  The system wants to ensure all of the funding for new roles is utilised, that the new roles support the delivery of local plans, and that moving staff into the new roles does not destabilise any local organisations or departments (e.g. the ambulance service, the physiotherapy department).

At the same time many CCGs are in the throes of merger, and moving into larger organisations more distant from individual PCNs.  Without action it is easy to see this gap getting larger and more problematic.

The need to close this gap is urgent.  Many areas are shying away from an honest conversation between PCN leaders, the LMC, and the CCG because it is difficult to get to a shared place on what is, for example, the future of access hubs given the national framework, or the need for a multi-agency PCN board when there is no current national requirement around this, or even what realistic expectations of PCNs are given their limited capacity.  Too often local systems are over-reliant on an expectation that national directives will close this gap for them, when this rarely proves to be the case.  With the gap widening seemingly with every passing week, this conversation, or series of conversations, is both essential and urgent.