Where next for PCNs?

The ambition of policymakers to scale up general practice is not new, but the scale and pace of the change required to deliver PCNs is. Implementing the networks in the context of major pressures in general practice represents a risk for NHS England. For PCNs to meet the broader objectives of policymakers for primary care, they are likely to require:

  • funding – which must represent a genuine increase, distributed equitably
  • the promised workforce – distributed equitably
  • improved recruitment and retention of GPs
  • time and support for implementation, including organisational development and leadership support
  • meaningful monitoring, and a support offer for struggling networks
  • the ability of the wider system – including nascent ICSs and established secondary care, community care and social care providers – to work collaboratively with PCNs.

Underpinning all of this is the importance of building relationships to create meaningful collaboration. PCNs require practices to move beyond their traditional boundaries. Sharing financial resources can both generate and strain relationships, and practices will have to trust each other if sharing both staff and data is to benefit patients.

From a policymaking perspective, PCNs may have evolved partly as a pragmatic solution to the difficulties in recruiting and retaining GPs – but the networks also contain a bold vision for the future of general practice and primary care. They are simultaneously a vehicle for stabilising general practice, and one through which significant change and service improvement is expected if the pledges of The NHS long term plan are to be met.

For patients and the public, much will depend on what happens once the agreements are in place and contracts put in motion. If PCNs meet national expectations, patients stand to benefit from access to a wider range of services through a stabilised general practice. Better use of medications, less reliance on hospital care and improved links with other services in the community are among the prizes on offer.

There is no one version of what success for PCNs will look like – and neither is it clear what failure would entail. It is patients who will feel the effects of either scenario. PCNs are a significant change within a complex system – and general practice isn’t embarking on it from a position of strength. The same need that has in part driven the formation of PCNs means that there will be little resilience left in general practice should they falter or fail.

It is vital that a safety net is created to identify and support PCNs that struggle, and to ensure that resources are distributed equitably, in proportion with deprivation and health need. The challenge of implementing PCNs must not be underestimated. Sufficient time and support must be given for genuinely collaborative relationships to develop in a part of the health system that has historically placed great value on its independence and close relationships with its patient population. Otherwise the breakneck pace of PCN implementation risks undermining the ambitions of the policy.

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