I was sitting in a nascent PCN’s meeting recently, and watching the practices grapple with the challenges of forming a new network, and at the same time thinking of the quite common advice for PCNs to establish a common purpose.  Sitting there, I imagined saying to the practices that what they needed to do was spend time identifying and agreeing a common purpose, and equally visualised my rather speedy subsequent removal from the room.

I understand that forward thinking practices can get to the place of considering what the purpose is of their shared network.  But for most practices the current challenges are agreeing who will be in the network, who will be the leader, how they will make decisions, who will hold the money, and how they will deliver extended hours.  There is no time (or patience) for esoteric questions about purpose, when there is so much that needs to be done in the little time they have together.

Does that therefore mean that those PCNs who have not explicitly addressed the question do not have a purpose?  Or is the (unspoken) purpose enabling practices to do what they need to do to fulfil the contract, and receive the funding and resources to which they are entitled?  If there is no purpose at all, you could argue practices would have rejected the Network Contract DES.

Framed more positively, is, then, the (unspoken) purpose of PCNs to increase investment in, and the sustainability, of general practice?  Is it to reverse historic underinvestment and enable general practice to emerge from its current crisis?  Are PCNs in fact a “lifeboat” (as it was termed at a recent Nuffield Trust event) for general practice?

I co-authored a book entitled the Future of General Practice, in which we explored what practices who had emerged from the current crisis had done.  Broadly speaking they have introduced new roles, found ways of working at scale, and began to form partnerships with other providers in the wider system – all elements of the new PCNs.  Like them or loathe them, there is no doubt PCNs represent an opportunity for general practice to create a more sustainable future for itself.

Is it ok for the purpose of PCNs to be first and foremost about investment in and the sustainability of general practice?  As we discussed last week, the system wants PCNs to be about the integration of general practice with the wider system.  And can anything in the NHS be about anything other than improving outcomes for patients?

I would argue that if the system partners with a general practice that is essentially broken, the benefits will be limited.  And if supporting general practice is the way to improve outcomes for patients, then it is perfectly reasonable for that to be its primary goal.  Where general practice is in crisis, the purpose of PCNs needs to be to support them out of it.  Integration with the wider system, and improved outcomes for patients, will be happy bi-products of this primary purpose being fulfilled.

The challenge for PCN leaders is to be clear on the purpose of their PCN.  While the discussion might not explicitly have been had, GP leaders will know why their colleagues are turning up and what their expectations are.  I think there is actually real value in these leaders making the implicit explicit, and using this positive articulation of exactly what it is practices are doing together to give energy to the PCN from member practices.  Ultimately, practices, the wider system and patients will all benefit from this.