Two weeks ago the BMA reported that it had rejected what it terms “the government’s rescue package” and that it was to take a ballot with the profession on industrial action.

The specific motion passed by the GP Committee contained two clauses directly pertaining to PCNs. It:

ii. calls on all practices in England to pause all ARRS recruitment and to disengage from the demands of the PCN DES
iv. calls on all practices in England to submit undated resignations from the PCN DES to be held by their LMCs, only to be issued on the condition that submissions by a critical mass of more than 50% of eligible practices is received

What does this mean for PCNs?  There are effectively three requests being made of practices in relation to PCNs.  The first is to pause ARRS recruitment.  Unfortunately ARRS recruitment is the one part of the PCN DES that many practices consider to be value adding.  Whilst there are some whose primary concern is the clinical supervision, line management and estates challenges these roles can create, increasingly practices are able to realise the benefits of these additional staff on their workload and outcomes for their populations.

It is hard to understand how sending a message to practices and PCNs to stop recruitment into these roles, the one thing that is helping with overall workload, is helpful in the current context.  Do we think that collective pausing of recruitment for a few weeks or months will influence the government/NHS England?  The downside of the suggestion seems far more detrimental than any potential upside.

The second is the call for practices to disengage from the demands of the PCN DES.  There is an anger amongst many that the delivery expectations on PCNs have been ramped up so steeply from October 1^st.  The number of IIF indicators (the ‘PCN QOF’) has gone up from 6 to 19 for the last six months of the year, along with a requirement to deliver against two additional DES specifications (health inequalities and CVD prevention and diagnosis).  Disengaging will, however, potentially cost the practices of an average PCN £120k (what they could earn through delivery of the IIF indicators, which are also linked to the delivery of the two specifications).

The third is the submission of undated resignations from the PCN DES by practices. This suggests that the reason practices participate in the PCN DES is because they want to support the government’s/NHS’s desire for PCNs to exist.  In reality there are two reasons.  The first is that PCNs make sense financially for practices, and the second is that practices believe that by working together as a PCN they can improve outcomes for patients.  While the initial decision to sign up was probably more for the former reason, as time has gone by more practices believe they can make a difference through their PCN.

The request, then, is for practices to sacrifice the benefits they receive and believe can be achieved for their patients in order to derail the wider national plan in relation to PCNs, to build influence in the debate on the issues of concern (i.e. the failure to address the crisis in general practice, the recently published plan around access, the GP earnings declarations, and for GPs to oversee the Covid vaccination exemption process).

I understand the desire for greater negotiating power.  The cost, however, falls on PCNs themselves.  While PCNs have been working hard to build trust across their practices, to create ways of working that benefit all, and to make a difference both to practice sustainability and patient outcomes, the effect of something like this is to set the whole thing back.  It makes it easier for the practices that have never really engaged to not do so, and makes it even more difficult for those who have been working hard to realise the benefits of joint working, because now the spectre of mass resignation can sit as a rationale for inaction.

So is it worth it?  Is the threat around PCNs worth the problems this causes to practices?  The Guardian reported that the BMA had won “significant concessions” from NHS England following its threat of potential industrial action.  These included the plan to publish ‘league tables’ – showing what proportion of appointments were in person – had been abandoned, along with specific targets.  However, the organisation seemingly responsible for setting policy in relation to general practice, the Daily Mail, reported that the Department of Health had moved quickly to insist it had made no concession to doctors’ unions, and that it would press ahead with measures to publish surgery-level data on face-to-face appointments.

Time will tell how this will all play out.  I fully support the push back by general practice to the NHS England paper on access, which was the NHS operating at its very worst.  However, I worry that not enough thought has been put into the consequences of conflating PCNs into a dispute that is not actually about PCNs.  Doing so is effectively self-harming for the service, and in particular it has left those in PCN Clinical Director roles, who are arguably doing the most for general practice right now, in a very difficult position indeed.