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by Dr Graham Jackson
27 June 2019
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Primary care networks (PCNs) represent a major shift in how primary care is delivered in England and we all have a stake in their success, says GP and co-chair of NHS Clinical Commissioners, Dr Graham Jackson.
PCNs have been called the building blocks of integration delivering primary care at scale in a more joined up and way with the aim of delivering better outcomes and improving the overall health of their local populations.
PCNs will serve populations of 30,000 to 50,000, putting them right in the ‘Goldilocks zone’ – not too small and not too large, but just right. In other words, they will be small enough and close enough to patients to deliver more personalised care at neighbourhood level, but just big enough to make a real impact on how patients access services and to provide much needed resilience.
They will do this through close collaboration between GPs and other providers in the community.
NHS England describes these networks as consisting not only of GP practices – although they will, in most cases, be led by GPs locally – but of a range of local providers from primary, and community and social care and from the voluntary sector.
The key to making them work will be in the ability of providers and commissioners to build truly collaborative partnerships, operating as a single system with services wrapped around the patient. Is it possible that the era of fragmentation is coming to an end?
Supporting the development of PCNs is a top priority for commissioners, as it must be for all providers within local systems. After all, this is about patients and delivering the most high-quality care possible – and commissioners and providers are both accountable for this.
As a GP, I appreciate the immense challenges that lie ahead for practices as they seek to form a network and begin delivering PCN services in July.
The practical support on offer from NHS England, the BMA, the RCGP and others is invaluable to practices as they try to navigate the new GP contract through which PCNs will be funded – and as they join together to form a PCN and appoint a clinical director to lead it – all the while continuing to deliver current services.
PCNs are at varying stages of maturity; some are a bit further down the road to integration but many are just starting out on this journey and will require significant support.
Locally, CCGs are playing a key role in supporting the development of PCNs – ensuring 100% geographical coverage and that registration requirements are met. They are working closely with their LMC and GPs to ensure all patients in England are covered by a PCN.
In the short to medium term, the networks will require support with organisational and leadership development, legal and contractual issues, and sharing of best practice.
Getting things right – including workforce and multi-disciplinary working, technology data sharing, and population health management – will be essential to fulfilling the vision set out in the NHS long term plan.
As PCNs expand beyond general practice over the coming years, the support that they will need must be coordinated across the sector and within integrated care systems.
Commissioners can also play an important role establishing links between practices and other primary and community care providers and with local authorities.
They can be leaders in driving the culture change that will be needed and in helping communities come together to support the development of PCNs at neighbourhood, place and system level.
At the national level, we all need to be thinking about how to respond to the evolving needs of PCNs in their broadest form, with representative bodies and trade unions working in synergy.
To do this, we must move forward with a shared vision and a common sense of purpose.
With that in mind, I suggest that now is the right time for everyone with an interest in the networks development and success – GPs, nurses, commissioners, social prescribers, pharmacists, mental health providers and physios – to come together to speak with one voice.
If we are to truly achieve integration, we must begin to think and act in a more integrated way.