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Clinical directors have responded to the BMA call for networks to be scrapped with all PCN DES monies to pooled into one funding stream.
PCN leaders say that achieving primary care at scale without networks is ‘unrealistic’ and they urge the BMA to look at ‘what is working well and build on it rather than ask for the system to yet again be rearranged’.
Although there is currently no clarity on what will happen to PCNs when the five-year contract comes to an end in April 2024, many are working towards becoming integrated neighbourhood teams (INTs) as set out in the Fuller stocktake.
The plans for evolving into INTs were forecast for 2023 – but there is little in the way of an official timeline.
While NHS England has guaranteed ARRS staff will remain in-post – with a new ARRS target in place via the long-term workforce plan – how that could work without PCNs is also unclear.
The NHS Confederation also warned that disbanding PCN would be nothing more than ‘distracting structural reform’.
However, in last week’s BMA annual representatives meeting (ARM), a proposal – which never made it to debate – similarly called for the BMA to negotiate to ‘get rid of PCNs and move its investments’ into the core GP contract.
Senior reporter Jess Hacker asked three clinical directors for their thoughts on proposals to scrap PCNs.
Dr Sarit Ghosh, clinical director for Enfield Unity PCN:
The theory you could still work at scale without the necessary levers that the Network DES brings is unrealistic: it would be completely reductive to scrap PCNs.
Currently, in return for working together practices get staff, additional streams of funding and the support of additional management and clinical leadership. By devolving this to practices you potentially lose these incentives, instead of collaborating you will see more practices work in silos and struggle to implement transformational change.
The established PCNs will likely remain and become stronger with at scale delivery widening the variation within primary care. This is not even taking into account the major disruption a change would have to the ARRS workforce who could be significantly affected and may lead to practices competing for existing staff and encountering retention issues.
Really, the system needs to support PCNs rather than get rid of them so that those who are not equipped to deliver effectively are given the time and resources to develop.
Dr Laura Mount, clinical director for Central and West Warrington PCN:
Rather than scrapping and starting again we need to be building on the successes and support those PCNs that need help to get there. We need strong networks to deliver on the long-term aspiration of integrated neighbourhood working.
In the case of the BMA, they should consider looking at where PCNs have been a success and taking the positives forward, particularly where there are common factors to success that that could be replicated. I trust that the BMA are currently heavily involved in negotiating the next five-year contract but they need to look at what is working well and build on it rather than ask for the system to yet again be rearranged. A strong PCN DES and GMS contract that rewards good patient care and supports primary care to deliver care that meets demand is desperately needed.
Dr Dan Bunstone, clinical director for Warrington Innovation Network PCN:
The work going on nationally under the digital transformation agenda is fantastic. PCNs are working with their members to create local and system change and embrace technology in really joined up ways. Some of that transformation would be possible without PCNs but the collaborative working and interoperability between surgeries at its core would be much harder to achieve. There are so many great examples of how working as a group of practices within a PCN have enabled the idea to become a reality.
In my PCN, we’re delivering proactive care on a massive scale to help support our patients maintain health by more closely supporting our patients with COPD and hypertension, to prevent worsening health in the future. We’re also focussed on hub working. Our PCN-wide triage hub, with aligned processes to enable our patients to access the right clinician at the right time. The goal is to try and reduce unplanned need, to create health within our system, and ultimately switch from a service responding to illness to one promoting health.
What we’ve achieved as PCNs hasn’t been achieved before in primary care, and certainly not at the size scope and scale. There is no question that primary care needs increased support and increased funding to achieve all that is being asked of it, but we are in a much stronger place. Within primary care, we’ve collaborated and innovated like never before.