We were all expecting a new GP contract in January, but few predicted the scale and speed of change it would bring. Back then, few GPs had heard of primary care networks (PCNs), but fast forward six months and almost all of us are working as part of one. Since 1 July, 1,259 PCNs have sprung in to being, covering all patients in England.
PCNs represent the biggest change in general practice in a generation. Pooling resources – including workforce and finances across neighbouring practices – will be a significant shift for many, both conceptually and practically. And whilst signing up to become part of a PCN was not strictly mandatory, with £1.8bn of the promised £2.8bn for general practice flowing through the network contract directed enhanced service, it arguably wasn’t much of a choice.
Implementing PCNs, let alone realising their potential, is a significant challenge. But the decision to direct much-needed additional funding and resource through PCNs rather than direct to practices is a clear signal that policy makers see scaling up as the best route to a more secure footing for general practice.
Widening skills mix and holistic care
Workforce woes – in particular a lack of GPs – is a major destabiliser in general practice. The NHS is struggling to find GPs and practice nurses, but it does have (or least plans to have) other health professionals such as physiotherapists, paramedics and physician associates. The hope is that widening the skills mix in general practice through PCNs, and employing more and a greater range of allied health professionals, simultaneously reduces pressures on GPs and enables patients to see the professional best able to meet their needs.
‘Personalised’ or ‘holistic’ care have long been favoured soundbites but, at their best, there’s a chance that PCNs could actually deliver healthcare that aligns with a broader understanding of what makes people healthy.
The current fragmentation of services benefits no one, and PCNs could become hubs for services supporting the health of communities - a GP practice offering housing support, community clubs, or even a gym? Primary care genuinely linked with local schools and community assets, such as local charities and activity groups? Wishful thinking maybe, but not impossible if PCNs are encouraged to make time and space for meaningful engagement with their communities, and have enough resources to respond.
Patient benefits of integrated care
Joining up primary care with secondary and community services has long been a policy goal. But achievement has been held back by several challenges, including how to actively involve general practice – a key provider of services but generally in small units – in wider decisions about how services are organised and delivered across geographical areas. In a system still dominated by large hospitals and specialist care, PCNs could bridge the gap, helping to raise the profile and voice of primary care.
How precisely PCNs and their clinical directors will work with emergent Integrated Care Systems remains to be seen, but the relative underrepresentation of primary care at system level has long been ripe for change.
If PCNs can meet the hopes of policymakers then patients stand to benefit from access to a wider range of services, delivered through a stabilised general practice with access to better data to help understand their local population and respond to their medical and social needs. General practice is not approaching this change from a position of strength, but nor can it afford to fail. The size of the prize is enough to keep eyes firmly on it.
Dr Becks Fisher is a GP in Oxford, a Senior Policy Fellow at the Health Foundation, and one of the authors of the briefing paper: Understanding Primary Care Networks Follow Dr Fisher on Twitter: @becksfisher