Local GP leaders say the move - which forces two proposed smaller networks into a single larger organisation - risks alienating local doctors and will be 'worse for patients'.
They warned that the rejection of practices' plans to form two PCNs - either one of around 27,000 patients and another of 34,000, or two with just over 30,000 each - showed that promises of autonomy had been scrapped in favour of 'bureaucratic convenience'.
The five-year GP contract agreement published in January said that an 'entirely bottom-up'' approach to forming PCNs may not work. But it said only that 'marginal adjustment' to PCN membership may be necessary - suggesting this would be mainly to avoid leaving 'a small number of practices and their patients behind'.
Dr Nick Grundy, a GP involved in drawing up the PCN proposals, wrote on Twitter that it was unacceptable for 62,000 patients to be 'forced into a single PCN against natural geography, council guidance on neighbourhoods, community organisations and preferences of practices purely to meet [NHS] bureaucratic needs'. He pointed out that forcing the two proposed PCNs into one was 'not minor adjustments as per the contract'.
The dispute over PCNs in Richmond CCG - which falls under a south-west London CCG alliance - comes after a third of GP partners taking part in a GPonline poll said their CCG had tried to control the shape and make-up of primary care networks in their area.
In a letter to GPs, Jonathan Bates, director of commissioning for south-west London CCGs said that an expert panel had concluded that 'the option presented to them of having one larger PCN of 62,000 registered patients would best serve the patients'.
He said that 'the creation of two neighbourhood teams' within the larger PCN could help practices achieve the local focus they were targeting. The letter said one option put forward by the practices had fallen foul of restrictions on PCNs having fewer than 30,000 patients apart from in rural areas, and the other had been ruled out because it involved splitting the list of a practice between two PCNs.
Primary care network
Dr Grundy, however, told GPonline that doctors behind the PCN proposals had been given a steer that the proposed split list would be acceptable. He pointed out that the contract agreement does not appear to rule this out, stating: 'Normally a practice will only join one network. It is likely that most network areas will not overlap, but this is not an absolute rule.'
Dr Heather Bryan, a clinical director appointed to run one of the two proposed PCNs, has written to Mr Bates expressing disappointment over the CCGs' decision. She wrote: 'The prospect of forming a large 62,000+ PCN is, of course, precisely the situation we feared we would be forced into and were working hard to avoid.
'This would make Teddington & Hampton disproportionately large with respect to the other Richmond PCNs, all of which were arranged in collaboration with each other to keep a consistent size and feel for practices and our patient populations. If forced into a 62,000+ PCN, we would immediately begin in contravention of the sensible 30-50,000 network size proposed by NHS England, a size we were careful to achieve with our configurations for the application.
Denying the options for smaller Teddington and Hampton networks will be ultimately worse for patients, who will be less likely to benefit from geographically sensible, locally arranged services as they evolve. Asking a single Network to subdivide itself into 'Neighbourhoods' is not impossible to imagine, but not what we were originally tasked with, and presents a frustrating, additional barrier to rational arrangements as a new PCN, entailing considerable further expense and time resource.'
A spokesperson for Richmond CCG said: 'We are in discussions with the applicants for the Teddington and Hampton primary care networks to ensure we meet the requirements of the NHS England guidance. We are working to find a local resolution. In south west London applications for primary care networks are being considered by a joint panel made up of lay members, primary care representatives and the local medical committee.'
GPonline revealed earlier this month that the average PCN could end up being significantly larger than NHS England’s proposed standard size of up to 50,000 patients.
Speaking at a Westminster Health Forum event deputy national medical director of primary care for NHS England Dr Raj Patel said he was expecting there to be a total of around 1,000 to 1,050 PCNs across the country - suggesting an average size of around 57,000 patients. The size of emerging PCNs across England varies from around 26,000 to more than 100,000 patients.