There was an interesting recent debate on one of the national WhatsApp groups about whether there is a role for an independent national PCN voice. Opinion was divided, with strong proponents both for and against.

The argument for goes along the lines that PCNs are something new (with a new cadre of PCN Clinical Directors) doing something different and more inclusive than general practice, and hence need to be represented at a national level in a different way to the GPC/how core general practice is represented.

I think there are two main reasons why this is not a good idea. First, it will weaken the national voice of general practice. General practice remains in crisis, despite the new contract and the formation of PCNs. It is critical that general practice retains a strong national voice. It currently has this through the GPC. If a separate voice for PCNs develops, it risks enabling the government, NHS England and national bodies to bypass the GPC, and push initiatives and new ways of working onto general practice via the PCN route. The greater dependence general practice has on PCN funding, the greater this risk becomes.

Second, it could limit local PCN flexibility. There are people working hard to try and enable the development of PCNs to be determined at a local level. One of the key strengths of PCNs is as local network enablers, bringing general practice together with a wide range of local stakeholders for the betterment of local outcomes. Each place is different, and will need different strategies and ways of working, and (more importantly) will want to control how this happens for itself. The old mentality of being dictated to from on-high needs to be replaced with a vibrant local determinism, a shift far less likely to happen if a national PCN representative body exists.

PCNs do, however, need a strong voice within their local integrated care system (ICS). Part of the PCN Clinical Director role is to represent the PCN within the local ICS, and how effectively this happens may determine whether there is any overall shift of resources (and workload) from secondary to primary care, and whether the system invests in primary care.

The key to this voice being strong is for general practice to ensure it presents a united front locally. If general practice is represented by a federation, the LMC and PCNs, none of whom can agree on what they want or how they want it, the voice is divided and the overall voice is diluted. Ultimately this internal division will end up in less resource being shifted to primary care.

The desire for a separate PCN voice comes from a sense of some GPs and practices not feeling represented. The solution, however, is not to create a separate voice for them, but to work hard to establish an inclusive, strong, unified voice for general practice, and to work to overcome the often historic barriers and disputes that exist within general practice for the benefit of all.

Here at Ockham Healthcare we have produced a free guide for PCNs which outlines 10 practical steps for PCNs to establish a powerful voice. It is free for subscribers – to subscribe simply click here. A unified PCN voice at a system level, and a single general practice voice at a national level, will maximise the overall impact of general practice on the system, and increase its chances of emerging from its current challenges.