Dr Stephen Haywood, a partner at the 1,950-patient Adderlane Surgery in Northumberland, told GPonline that he felt joining a network could put at risk the model of care that has helped the practice achieve 96% patient satisfaction - a score far above the national average.
Across England, 99% of practices are part of one of the 1,259 PCNs set up from 1 July. An NHS England document published in June revealed that just 26 practices had chosen not to join a network.
An 'army' of 20,000 additional healthcare workers, including clinical pharmacists and social prescribers, are to be recruited through PCNs, to relieve GP workload by taking on an increased number of patient consultations.
Continuity of care
But Dr Haywood said a key reason for his practice's decision not to join was a fear that this approach could affect continuity of care and worsen levels of service.
Giving multidisciplinary teams greater responsibility for carrying out minor consultations could weaken patient-doctor relationships and 'dilute quality of care', he warned. Dr Haywood said he was also put off by concerns that joining a PCN would add to practice workload - taking doctors' time away from patients - and because he felt that financial incentives on offer through PCNs did not reflect the extra energy his team would have to dedicate.
But he admitted that his practice could be persuaded to join a network, should new opportunities arise that give PCNs greater influence over local health management.
The Northumberland GP said he was aware that there may be a perception that those who had not joined networks were ‘bad practices’ or wanted to be 'awkward'. But he explained that for his practice, the decision had been led by a determination to protect the patient-doctor relationship.
‘The thought of bringing others in to do the "easy work", those consultations that may take less time - well, I’m not sure this will necessarily be beneficial in the long run,' he said.
‘We think that the more minor consultations are just part of the way in which doctors can build up a relationship with the patient, allowing them, in the long term, to deal with the more complicated concerns more effectively. I think we dilute that and restrict that at our peril.'
Despite Dr Haywood's reservations, many practices are advocates of broader use of multidisciplinary teams in general practice. At the RCGP annual conference last month, Derbyshire GP Dr Gail Allsopp spoke about the advantages of using the wider healthcare team, revealing that the introduction of a GP consultant role had helped her come back from the brink of burnout.
By allowing clinical pharmacists and others to take on more consultations, she argued that GPs had more time to spend with patients with more complex needs.
Dr Haywood said that for the two GPs at the Adderlane Surgery, time was precious but the current balance meant they enjoyed a relatively low-stress working environment - one that could be disrupted by joining a PCN and having to attend regular meetings.
‘If you have eight GPs you can release one to go to a meeting,' he said. 'But if you only have two it’s much more tricky… if you’re going to stick something else in then you need to make sure that it is of benefit, and we’re just not convinced that’s happening.
'We are all conscious of pressure upon us - we don’t want to be spending time ineffectually.'
Dr Haywood revealed that a neighbouring practice had also decided against joining a network for similar reasons; something which he said had made it easier to resist calls from other practices and the CCG to join a PCN.
He added: ‘I think it’s often the case that we get policies introduced that are necessary in London but potentially harmful in other parts of the country. We feel that what is on offer [through PCNs] is a particular vision of general practice, which we don’t share, and so to not be a part of that is not a problem for us.'
Although Dr Haywood ruled out the possibility of his practice joining a network in the near future, he said his practice could change its stance if new opportunities were brought to the table.
‘The question is to look at how they develop and what their ideas are. If it’s not developing much beyond this, then I’m not really too excited and I suspect that we won’t be joining.
‘But if PCNs took over the management of district nursing or health visiting, for example, that could be quite useful and makes a broader, more effective health community - we’d be more interested in that.’