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The PCN honeymoon period is coming to an end



One year on, with a global pandemic in the mix, primary care networks have become the saviours of general practice. Or so the Government would have us believe. They have been sold to the profession as the only way to improve resilience and the glass-half-full GPs have jumped on board.

Call me cynical, but I just don’t buy into this agenda. It’s not that I don’t see value of collaboration, I just want it to be on my terms.

For years, successive governments have struggled to come up with ways to try and control those pesky GPs, running their own fat-cat businesses, in any number of Machiavellian ways. How better to achieve this than by freezing individual global sums and forcing starved practices to join networks, where all future funding is to be directed? Individual practice identities will slowly dissipate, as more and more non-core funding starts flowing through networks.

It is much easier for NHS England and CCGs to do business with five or six networks than to be dealing with multiple small businesses. But this isn’t even the best part. In time, practices will start policing each other within PCNs, as the number of network ‘carrots’ increases via the new investment and impact fund that promises PCNs more riches.

So, the masterstroke is that GP practices will actually performance manage each other, in a mission to remain within budget and hit targets. In time, there will be so many challenges to retaining individual practice and partnership status, that many network practices will just merge to provide the larger building blocks required for an integrated care system.

It’s not that I don’t see value of collaboration, I just want it to be on my terms

As primary care is forced down this road, I am left wondering about secondary care.

For those of you working in a practice that faces one trust, one CCG and one local authority – count yourself among the lucky few. The rest of us are caught in the crossfire of multiple rules, pathways and, worst of all, characters.

Two patients may have the same condition, or be on the same drug, but if they attend different hospital trusts, they may each have their own clinical pathway or shared-care protocol, according to the wishes of that department. I am currently working within a system where there are four different shared-care protocols for methotrexate, depending on the initiating trust and department. It is unacceptable for a GP to have to remember different referral criteria or different drug-monitoring regimens, for different patients within the same practice.

There’s little incentive for trusts to collaborate – unless, as with GP practices, the oxygen supply of their individual funding streams is cut off. So, we need to demand that trusts form SCNs – or secondary care networks.

And while we’re at it, let’s throw in a few other gems from our contract. I’m sure our consultant colleagues would love to be told to code a depression review or to ask about someone’s alcohol intake. After all, we’ll be driven down this emasculating QOF pathway again as soon as the PCN honeymoon period is over. And that is fairly soon.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs here