Our worried friend in the Midlands, Dr Manu Agrawal, sets out his concerns for traditional practice as demands on PCNs grow
I am both excited and nervous about the future of PCNs. I’m excited about the role that general practice and PCNs have played in the mammoth task of vaccinating our population. Despite years of underfunding, vilification by the media and constant contractual threats, general practice has shown again why it is the most reliable, trustworthy bedrock of the NHS.
However, I am nervous because traditional general practice, the cornershop model, which actually looks after 85-year-old Joe Bloggs, is under a threat like never before. That threat is from integrated care systems (ICS) and PCNs.
This is evident if you read the NHS England Long-Term View. You can count on one hand the number of times general practice is mentioned. Well, it is only a small part of the NHS delivering just 90% of the activity for a mammoth 10% of the budget. In contrast to this is the repeated mention of PCNs. Is general practice going to be represented in the future NHS by a DES? A group of geographically co-located, often conflicting practices, which signed up to an ‘optional’ DES because our leaders in the BMA General Practitioners Committee linked it to contractual uplifts?
Don’t get me wrong. PCNs have brought practices together. They’ve delivered the vaccination programme while recruiting for the additional roles reimbursement (ARRS) scheme. But compare the funding diverted to ARRS and PCNs with the investment going into core contracts – £11 per patient this year and £15 next year. If this funding had been given to general practice it could have prevented incomes being reduced. It would have made general practice a desirable specialty again. It would have given practices freedom to employ who they want as per their needs.
PCN clinical directors are the most underfunded and overstretched people in NHS employment. We do it for the sake of our practices and patients. But it is a huge ask. I’m not sure how a jobbing GP suddenly gets the knowledge to deal with corporate people on ICSs, who have protected salaries and bonuses at the end. One mistake from a PCN clinical director could wipe out our budgets.
And I’m sure the system leaders’ solutions are to incorporate PCNs, start holding GP contracts through PCNs and create larger partnerships, ticking the box of saving the independent contractor model, and making the whole profession, barring a few, salaried.
This is where I believe PCN clinical directors, LMCs and local GP leaders should start saying ‘no’. This is the most powerful word, which you don’t hear in the NHS. We should say no; to when the ICS wants to move traditional GP-led services into PCNs; to when QOF will be moved into PCNs; to when we will be forced to merge our contracts; to when the whole commissioning role becomes the responsibility of PCN clinical directors.
But there is also a ‘yes’. Yes to developing new services and pathways, with new funding, moved from secondary care into primary care. And this is where PCNs give us an advantage.
We can be proud of what we have achieved in this pandemic. We have stayed open, looked after our patients, picked up secondary care’s work, and we are the cornerstone of the biggest vaccination programme in our lifetime.
Dr Manu Agrawal is clinical director for Cannock North PCN, Staffordshire, senior partner managing three practices in three PCNs and treasurer for South Staffordshire LMC