The Long Term Plan published in January of this year said, “Every integrated care system will have… full engagement with primary care, including through a named accountable Clinical Director of each primary care network.” (1.52)

The GP Partnership Review, published shortly afterwards, said, “Working at scale, for example through Primary Care Networks, has the potential to improve and support general practice influence at a system level.” (p35)

The question is will the establishment of PCNs and the new Clinical Directors really mean that general practice has a voice, and be able to influence outcomes (and the flow of resources) at a system level?  You could argue the establishment of Clinical Commissioning Groups as statutory bodies was supposed to achieve just that, yet they have presided over one of the worst periods of under investment into general practice in NHS history.  Clearly setting up an infrastructure doesn’t of itself necessarily translate into a bigger voice.

Of course, some might argue, CCGs were commissioning organisations and PCNs are provider organisations, so this time it is different.  It is hard for the average GP not to be cynical about yet another promise that “this time it is different”, after so many previous identical promises failed to deliver.

We are heading in the direction of c1000 Primary Care Networks (PCNs) across England.  There are 44 STPs, so we are looking at c20 PCN Clinical Directors per STP.  Even though this is hugely more manageable for system leaders than 7,000 GP practices (c150 per STP), it is difficult to overestimate the challenge for each one of those 20 Clinical Directors trying to influence for their particular PCN.

In the model of “place-based care” (NHS-talk for providers from across health and social care working together at a PCN level), you could argue PCN Clinical Directors will be leading and shaping the integration of services locally.  However, this also depends on whether the reality of how place-based care works is bottom-up (decisions made by local teams), or top down (decisions made at STP level, and PCN leaders asked to implement them).  This in turn will depend on how influential the PCN leaders are at STP level.

The challenge facing the new Clinical Directors of PCNs is formidable.  They have to introduce joint working across GP practices that have never really worked together previously, and manage all the inevitable internal disputes and conflicts that will arise, before they can even start thinking about how they will work with local partners, and how they will create a strong voice for local general practice.

My sense, however, is that it is important to start as you mean to go on.  While the odds may initially be stacked against PCN Clinical Directors, the reality is the system needs them more than they need the system.  There is the opportunity to influence, but only if it is seized and taken from the start.  It is not going to come on a plate, and the new leaders of primary care will need to work hard to establish their voice.  Done badly, the voice will not be strong.  But done well, I think there are many gains to be had for PCNs, their practices, and their local populations.

It is with this in mind that here at Ockham Healthcare we have created a brand new (free) guide for PCN CDs on how to establish an effective voice.  It includes 10 practical steps PCN leaders can take to make their voice effective.  If you are already on Ockham Healthcare subscriber you will receive the guide free via our weekly newsletter on the 9^th May.  If you are not a subscriber just sign up here (for free) and we will email you a copy.  I hope you find it useful, and good luck with finding your voice.