Primary Care Networks
By Dr Mark Sanford-Wood,
Medical Secretary at Devon Local Medical Committee and Deputy Chair at the General Practitioners Committee
General practice is no stranger to collaborative working. We have been doing it for years, whether in federations, localities, collaborative groups, GP forums or simple buddying arrangements with neighbouring practices. So people could be forgiven for thinking that Primary Care Networks (PCNs) as defined in the new contract deal will be just another iteration of a well-trodden path. Yet for the first time the formation of defined practice groupings will receive significant NHS investment for activity and new staff that will be the springboard for the revitalisation of general practice at the core of community care.
PCNs will be built on existing practice structures and the associated funding will flow to the PCN from its constituent practices via the GMS/PMS contract through financial entitlements defined in the new Network DES. This places GPs at the heart of planning and puts them in the driving seat. PCNs will therefore be for GPs to define, with practices retaining control and leadership. For those suspicious of a command and control agenda this re-iterates, with financial backing, the centrality of GPs to the delivery of care at community level and re-confirms GPs independence and leadership.
PCNs will cover a hard minimum population of 30,000 and will have a maximum guide population of 50,000. Where current working models have groupings that work well and are established there will be some flexibility in the upper limit. Existing provider structures may form a useful basis for the footprints of PCNs with successful federations defining an outline that may encompass a number of networks. The federation would then act as a network of networks to help coordinate PCN activity across a larger locality geography.
The decisions around network footprints will ultimately rest with the practices themselves, with the clinical commissioning group (CCG) and LMC facilitating discussions to ensure that every practice has the opportunity to join a PCN. It is agreed with NHS England that guaranteeing PCN membership to all practices is the main function of CCGs and LMCs in this process and that there should be no attempts to coerce practices into network configurations favoured by other actors in the system. PCNs will be of GPs, by GPs, for GPs and their patients.
With this in mind it is vital that you initiate those dialogues with your neighbouring practices and form your PCNs now. This is your right, your function and your responsibility. A model PCN agreement will be published shortly for your practices to use to help set out how your PCN will function. An important part of this will be the question of who will lead your PCN. There is protected funding available in order to release a GP for one day a week (for an average 40,000 patient network) in order to lead and coordinate PCN actions. These will be called the PCN Clinical Directors.
This will be an exciting opportunity for many GPs who have innovative ideas, but have so far lacked the stage on which to try them out. This will be your PCN and your innovations will require no consent other than from the practices in the network. As an early developmental opportunity for these new PCN Clinical Directors Devon LMC is laying on an event on the evening of Tuesday, 21 May at Fingle Glen, near Exeter, to help begin your development and offer networking opportunities with other PCN Clinical Directors, many of whom will feel equally excited and challenged.
PCNs will receive significant new investment to begin to build a workforce to deliver on services that are still being defined, but which will also help to take some of the strain off practices in delivery of general practice. The guaranteed investment in networks over the next five years is a huge opportunity for general practice. Find out more by coming to the GPC Roadshow on Thursday, 7 March at Exeter Racecourse where you can ask any questions and find more details and if you think you might want to lead your PCN then put the 21 May in your diary.