A total of 1,259 networks went live in July, bringing GP practices together across populations of around 30,000 to 50,000 patients in most cases.
But with some practices having pre-established working relationships, there have been concerns that those without these links could be left behind.
National clinical advisor for primary care Karen Kirkham has warned that PCNs at the lower end of the maturity scale are potentially years behind the most developed networks, with practices in some areas only just starting to talk to each other.
The Dorset GP emphasise the importance of allowing immature PCNs time to develop, urging commissioners to pay 'close attention' to those that struggle to do so. She echoed concerns expressed by some PCN clinical directors that too great a focus on high-achieving networks could be counterproductive - warning commissioners that 'differential outcomes' could begin to emerge.
Developing maturity
Speaking at the Urgent Health UK annual conference, the Dorset GP said: ‘My sense is that it is going to take two to three years [for immature PCNs] to get to that sort of maturity because these practices are not used to working together necessarily - they need a lot of organisational development.
‘In some areas there are some real front-runners and some just finding their way - just even starting to talk to each other. So I think we have to accept that it is going to take some time [for them to fully develop] and it’s really important to give people time.’
Clinical director of Bridlington PCN in Yorkshire Dr Zoe Norris warned last month that NHS England could see a mixed bag of results if it failed to support networks with freshly developed links.
Dr Norris reported some clinical directors she had spoken to had been left feeling ‘overwhelmed’ by the new arrangements, warning that not all PCNs were ‘ready to take on the world’.
Dr Kirkham, who was reflecting on the success of PCN development in Dorset, said she was encouraged that the CQC appeared ‘very invested’ in working with struggling PCNs, but warned this was not enough.
She added: ‘I always say that the system needs to wrap around the networks. The ones that are up and running, the ones where relationships are developing, they are kind of okay, aren't they? But we do need to put some real effort into those ones that are not developed.'
Variation
She added that a fixation on throwing money at fast developing networks could lead to variation in results seen by PCNs; a situation which she said needed to be monitored.
‘There is a really clear desire [within the network DES] for PCNs to reach an increased level of maturity. I think commissioners are going to have to keep a really close eye on that because some of this investment could start to drive a differential in outcomes.’
NHS England confirmed in September that PCNs failing to spend their share of funding for recruiting additional healthcare professionals were likely to see the money diverted elsewhere.
In 2019/20 PCNs can claim 100% reimbursement for employing a social prescriber and 70% funding for a clinical pharmacist.
