“The strength of the pack is the wolf, and the strength of the wolf is the pack.” Rudyard Kipling

There is a nervousness amongst GP practices in the intertwining of their fates with those of other practices through PCNs.  The move to robust PCN network agreements can be about protecting the higher performing practices from being ‘dragged’ down by those who are not doing so well.

Equally, as GP practices choose the PCN they are to be part of, there is a tendency for competitiveness between PCNs to emerge.  Instinctively many GPs and practices want “their” PCN to be more successful than those around it, thus justifying the choice of the practice to join it in the first place.

Anyone working in general practice at present understands the pressure that the sector as a whole is under.  When faced with such an existential challenge, there is real value in working together to meet the challenges rather than shifting to a ‘survival of the fittest’ type attitude.

This is perfectly illustrated when considering the respective plight of lions and wolves.  It is estimated there are 20-30,000 lions left in Africa.  50 years ago there were 450,000 lions, a decline of more than 95%.  While historically their numbers had grown, the emergence of man as a predator of lions is the major factor behind their decline.

However, what is astonishing is that the majority of lions are still killed by other lions.  In some prides 80% of the cubs don’t survive.  Either they are killed by other males, or they don’t get enough to eat (they typically eat last in the hierarchy of the pride).  Lions evolved without a predator with an instinct to dominate the savanna from each other, not to share it.

The similar emergence of man as a predator of wolves resulted in the number of wolves declining by about a third.  However, their population is now relatively stable at about 300,000.  Wolves care for each other as individuals.  They form friendships and nurture their own sick and injured.  Pack structure enables communication, the education of the young, and the transfer of knowledge across generations.  The older wolves, as more experienced hunters, share hunting strategies and techniques with younger wolves, passing down knowledge from one generation to the next.

While lions collectively struggle because of their individual desire for dominance, wolves succeed because they cooperate and support each other.

The lessons for newly formed PCNs are clear.  Do we build PCN governance structures to ensure the most successful practices aren’t negatively affected by the practices that are not performing as well, or is the aim to support all practices regardless of their starting point, and to help those most in need to improve?  Do we share information, ideas, resources, expertise with other PCNs, or do we keep it to ourselves and leave other PCNS to work it out for themselves?  Do we collaborate with other PCNs to create a strong voice for general practice, or do we let inter-practice and inter-PCN disputes weaken our collective stance, as we argue against each other in public so that others can simply ignore the general practice position?

We should judge PCNs not on how they are performing relative to other PCNs, with metrics devised by the system, but on how well they are supporting their member practices, and the extent to which they are enabling general practice to thrive.  The more both practices within a PCN work collaboratively together, and PCNs work collaboratively together with each other, the more general practice will thrive.  It may even be we get to a place where “the strength of the PCN is the practice, and the strength of the practice is the PCN”!