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Are PCNs what we all imagined?

Hard-wired GP

Luke Koupparis

Friday, 13 September 2019

AdobeStock_245067019_PCN_blog.jpgEarlier this year, just as practices were starting to recover from the ravages of winter, a new contract was delivered. Part of this new contract was the advent of the Primary Care Network (PCN) covering 30-50,000 patients. Heralded by NHS England as a way to bring geographically contiguous practices closer together but with the addition of integrated working with the community, mental health, social care, pharmacy, hospital and voluntary services. If this wasn’t enough Primary Care Networks would be given the funding to employ staff with year one giving us social prescribers and pharmacists. The whole mantra was to make care more integrated to enable greater provision of proactive, personalised and coordinated care. Every practice would be encouraged to be part of a PCN across the country and if a practice didn’t join then their patients would be delivered all these great services by the ones who had. Leadership would be provided by a clinical director working two sessions per week per 30k patient PCN.

In addition, the contract would deliver a long-awaited pay rise to primary care who had effectively been starved of funding effectively since the advent of the labour-implemented 2004 contract.

It all sounded too good to be true. Sure, there were a few bits in the contract about practices not making additional profit out of PCN land, but there were additional staff and pay rises promised in subsequent years. Within five years these organisations will be huge with lots of allied healthcare professionals working to deliver truly integrated care and hence reducing the increasing pressure on declining GP numbers.

However, now we are a few months into PCN world, I wonder whether they are all they were cracked up to be? The reason I am increasingly concerned is that we appear to be creating a new organisation outside our practices. Currently the PCN has funding of £1.50 per patient in addition to the salaries for new roles and the clinical director post.

When you work out how much this equates to for an average-size PCN, it is not a great deal of funding (about £45k for a 30k PCN). When you start to calculate the cost of running all the meetings to get practices together, setting up a network contract, bank account/financial probity, VAT issues, PCN board, data sharing, management costs (I could go on..), plus fund any salary shortfall in the additional roles (e.g. pharmacists funded at 70%), you start to realise that this money will not go very far. PCNs also have to deliver extended hours for all the patients in the network regardless of whether every practice wants to actually do it.

The roles that have been chosen are very prescriptive and practices cannot use the staff funding to provide support in the areas they require. For example, it is not possible to fund prescribing clerks over pharmacists, care coordinators over social prescribers. It is a one size fits all approach.

In addition, all this takes time and it takes GPs and managers out of practice, when they should be putting energy and time into their core businesses. Most surgery businesses have budgets that far exceed the amount offered by this enhanced service. However, experience is that PCNs seem to be taking up greater amounts of time.

PCNs also seem to be heralded as the solution for many of the issues faced by other parts of the health economy. If the Emergency Department is just too busy, then just call on your local PCN which will be able to come up with a solution for all those patients who turn up to secondary care with a multitude of presenting complaints. This is even before PCNs are given more details on what the workload and outcomes are for seven national service specifications.*

I cannot help thinking that the agenda for PCNs is to move smaller practices into larger units that can be forced into dealing with wider healthcare issues as part of a move to Integrated Care Organisations. Originally heralded as the saviour of general practice, I wonder whether they might be the downfall of general practice as we know it.

Further reading

*By 2020: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. By 2021: cardiovascular disease case-finding and locally agreed action to tackle inequalities.

Author's Image

Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group, LMC representative and chair of the locality provider group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist and likes to ski with his children.
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