This site is intended for health professionals only

Iceberg ahead

We must protect core GMS contracts and the independent contractor model, or engagement will be shortlived, Dr Manu Agrawal warns in Pulse PCN’s spring edition

The titanic task of the NHS reorganisation is full steam ahead. The formation of ICSs is gathering momentum. The outgoing CCGs have been focusing on what the structures will look like. CCG chairs have suddenly decided to portray themselves as true representatives of general practice as they get involved with creating the new structures. All very understandable, and everyone is looking for a role in the new system. 

What remains unclear is the role of PCNs or, indeed, LMCs. 

I and my colleagues have being fighting during the last few months for the grassroots GP voice to not be ignored. We are looking at continuing the membership engagement that was set up for CCGs to ensure we have a voice. 

Where do PCNs sit in all this? The system wants PCN CDs to represent general practice at place level and every other possible level under the sun, but predominantly place. We’ve been advised that is where the decisions will be made, with other partners. In truth, we’ve had place for the past year and nothing tangible has come out of it, so I do not have high hopes about this.

The bigger concern I have is how as a CD I am suddenly making decisions on behalf of sovereign independent practices, which can affect their livelihoods.

The system just wants to talk about PCNs, yet England’s LMCs conference mandated the BMA’s General Practitioners Committee (GPC) to get rid of PCNs, or tone them down massively. This seems to have been ignored in this round of contract negotiations, though I hope I’m wrong. 

But let me seek a positive spin. At place, we have discussed how to do things differently – create pathways together and provide more services in the community, not by general practice, but by PCNs. This can be done if there is a political will to do it properly, without vested interest and by protecting core GMS contracts and the independent contractor model, otherwise the engagement will be very shortlived.

Then there are system leaders, some from a general practice background, who do not want the LMC voice and involvement. This is because the LMCs have an agenda – protecting GMS. Supporting the PCNs comes after that. 

The problem now is that a certain section of PCN CDs are conflicted or are trying to not engage with the LMC. This is dangerous. It will prevent us having a strong voice and undermine general practice. Call me cynical, but this divide-and-conquer atmosphere is something we should be wary of. 

We need to get shipshape. We need PCN CDs and LMCs to work together to protect the independent contractor model, using PCNs for facilitating changes that capitalise on the strengths of practices, rather than undermining them, otherwise there will be no practices to provide the care. When the next wave of reorganisation hits in five years’ time we want to ensure general practice is ready to weather it.

The system wants to work with us, let’s work with it, but together.

General practice is on a collision course with an iceberg. Our conversations do not harbour an element of surprise. Rather, there is an inevitability: ‘Captain – we know there is an iceberg, how quickly can we go into it?’

Can we work together and miss the iceberg?

Dr Manu Agrawal is clinical director for Cannock North PCN, Staffordshire, senior partner managing three practices in three PCNs and chair of South Staffordshire LMC. Click here to read more of his blogs


Patrufini Duffy 6 April, 2022 4:34 pm

The paradox is that the PCN model is the end to your true autonomy and independence. Sheep grouped up. And easily slayed. You are now more dictated to than before, and this is one situation where there is no safety in numbers. Think laterally, the box is the PCN.

Vinci Ho 8 April, 2022 10:43 am

Dear Manu
‘’The bigger concern I have is how as a CD I am suddenly making decisions on behalf of sovereign independent practices, which can affect their livelihoods.’’
That is one of the main reasons I decided to resign my CD position two months ago( alongside with burnout syndrome).
However , I remained elected committee member of our LMC in Liverpool embracing the controversies and challenges ahead ( especially enhanced access in coming October ) and the new IIF ‘QOF’

Vinci Ho 8 April, 2022 10:51 am

And I always would want to remain people of the Trilemna theory :
For :-
One can only have two out of these three but never three altogether in equal portions . Something has to be sacrificed.
To a large extent , this renders , arguably , the consequences of what we are witnessing in the world right now after a period of globalisation (Cf integration) followed by current protectionism ,and even imperialism (Cf sovereignty)

C Ovid 11 April, 2022 7:49 pm

Best way to avoid the iceberg is to put some dynamite in the hold right now and light the fuse.

Gary Free 20 April, 2022 3:24 pm

Unfortunately this article contains a number of inacuracies about the behaviour of the CCG chairs, who has been working on GP engagement and who has been looking at structures and form rather than functions.