PCNs must not become backstop for failing primary care services, GPs warn

Three out of five GP partners do not believe primary care networks (PCNs) should be expected to maintain services when practices close or extra primary care capacity is needed, a GPonline survey has revealed.

PCN roles (Photo: Universal Images Group/Getty Images)
PCN roles (Photo: Universal Images Group/Getty Images)

Under proposals put forward by NHS England, PCNs could become the 'default' option for maintaining primary care provision when a practice plans to hand back its contract or when an area needs a new practice.

But 60% of GP partners in England who responded to GPonline's latest opinion poll disagreed with the plans. Just one in five of the 151 GP partners who responded backed the proposal, while the same proportion said they were unsure.

Across all GPs responding to the survey - 440 in total, including salaried GPs, locums and partners - 43% opposed making PCNs responsible for maintaining primary care provision where problems arise, with 26% in favour and 32% unsure.

Primary care networks

However, with partners far more likely to report being informed and engaged with emerging networks in their area, overwhelming opposition to the move among this group is key.

The idea was floated by NHS England as part of its consultation on digital-first primary care, which is currently underway. NHS England has said the plan would remove the need for most local APMS procurements, simplifying procurement processes.

However, GPs and the BMA have said the proposals go against the idea of what networks were originally set up to achieve.

In its response to NHS England's consultation, the BMA said existing GP practices should remain the route through which primary care services are provided. It said PCNs had been established to better integrate existing providers, not to become providers themselves.

‘What is needed is for patients to join existing GMS practice lists, rather than newly set up commercial APMS providers… but this must be with GMS practices having required resource, capacity and support to do so,' the BMA said. 'It’s important to acknowledge that PCNs cannot absorb patients. They can absorb activity, their practices can absorb patients’.

Unrealistic expectations

There was a general consensus among GPs responding to GPonline's poll that it was unrealistic to expect PCNs to rescue struggling practices.

One partner said: ‘Primary care networks cannot take up the slack when individual general practices fold because there is no slack left. The problems are due to underinvestment over years and austerity in general which means many patients have nowhere to turn except general practice.'

Another partner added: ‘Sadly it appears to me that there is an expectation that GPs are going to sort out the problems for the NHS through primary care networks; how will this work? Primary care needs a political solution to solve the problems around recruitment and demand.'

Another GP said that PCNs' objectives to improve patient care would be thwarted if they were required to take on struggling practices. ‘It defeats the purpose [of the plans],' they said.

BMA GP committee chair Dr Richard Vautrey told GPonline: ‘There is a difference between PCNs being expected to fulfil a CCG-type role and maintain primary care provision and practices that will increasingly be working more closely together trying to avoid an unnecessary APMS procurement for one of their member practices.

‘PCNs should not be expected to take on the former role, but it's likely that many would want to explore the latter if that avoided destabilisation to services in the local area.’

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