PCNs are not popular in some quarters of general practice primarily because they are seen as a threat to the independence of the individual practice.  But is there a bigger threat to practice independence than PCNs, and could it even be that PCNs may become key to maintaining practice independence?

Funding and resources are increasingly coming to practices via the PCN route (as opposed to directly via the contract).  Inevitably alongside any additional funding and resources are increased delivery requirements.  It is the lack of direct control of the resources alongside the additional work which is behind much of this growing practice resentment of PCNs.

But more changes are coming.

Since October PCNs have taken over responsibility for enhanced access.  We are seeing a mixed picture of delivery across the country.  Some PCNs have taken over this delivery from the local provider, others have simply come to their own arrangements with the local provider and yet others have created all sorts of hybrids in between with mixed models of delivery and even whole new providers in place.

Now, we know from the Operating Framework that a “General Practice Access Recovery Plan” is on its way.  While we don’t know what will be in it, there are some elements we can predict.  Most likely is the number one action outlined in the implementation plan from the Fuller Report, which was to:

“Develop a single system-wide approach to managing integrated urgent care to guarantee same-day care for patients and a more sustainable model for practices.  This should be for all patients clinically assessed as requiring urgent care, where continuity from the same team is not a priority” p34.

Specifically, the report says that it is for, “primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them” (p11).

Very quickly, it appears, we may be in a place where PCNs are expected not just to offer extended hours across all of its member practices, but also a system for delivering all urgent appointments across core practice hours.

Let’s leave aside the mechanics of how the centre might expect to impose a system that takes away activity that is core contract activity (and, one assumes, also the funding that goes with it), and for arguments sake assume that this is what happens.  In this situation does a PCN really want to be outsourcing the delivery of these appointments to a third party provider?

It is one thing for a third party to be providing additional appointments on top of those that a practice has traditionally been expected to provide.  But it is another for such a provider to take on responsibility for delivering in hours appointments that have always been part of the core contract.

Even putting aside the impact this would have on the practices’ ability to deliver effective continuity of care, the threat to practice independence at this point surely becomes much more real.  If a practice is not responsible for one aspect of its population’s core primary care, what is to stop other responsibilities being taken off it?  Where does that road end up?

Meanwhile, the PCN remains a contractual entity owned entirely by it practices.  While individual practices may not be able to retain control of this agenda, groups of practices working together as a PCN can.  If the group can work together they can find a way through this that protects their collective independence.

So while there is a loss of control at an individual practice level in operating across the PCN, the group of practices can retain collective control by working together.  What the PCN provides is additional running costs, staff and resources to enable this joint working to be effective.   Now may well be the time for practices working together as PCNs to start considering how they can ramp up their in-house delivery abilities and reduce any reliance on external providers, as a means of protecting their collective independence.