What is a PCN?
A primary care network (PCN) consists of groups of neighbouring general practices that agree to work together to provide services across their registered populations. The PCN is required to share funds, but is not a legal entity. The PCNs were outlined in the NHS long-term plan in January 2019.
A PCN should cover a population of between 30-50,000 people and as a result there will be about 1,300 PCNs covering England. The PCNs are designed to sit geographically within an Integrated Care System (ICS) – a much larger organisation made up of partnerships of NHS organisations and local councils.
The practices within the PCN enter a network contract in addition to their core GP contract. Groups of practices collaborating as a network will have a designated single bank account through which all network funding will flow.
The NHS Long-Term Plan, published in January 2019, says the PCNs will be used to improve both primary care and the health of the broader population.
A GP practice does not have to join a PCN. However, £1.8 billion over five years for improvements to primary care is being channeled via PCN contracts, so it would be difficult for a GP practice to not join a PCN.
When did they begin?
In April 2019, the PCN directed enhanced service (DES) was launched as part of the 2019-20 GP contract. The key requirement in the first year was for practices who signed the contract to join a PCN.
By July 2019, around 99% of GP practices had signed up to a PCN resulting in about 1,300 PCN each covering 30-50,000 patients.
What will a PCN do?
PCNs will be the way to deliver direct enhanced services (DES), such as medicines management, healthcare in care homes and early cancer diagnoses.
Once a PCN is formed they will be responsible for delivering seven national service specifications set out in the contract in return for the new funding.
PCNs will be expected to use their current staff in the practices to deliver the services, but will also receive funding for new staff under the Additional Roles Reimbursement Scheme (ARRS). Roles that will get funding are: clinical pharmacists; social prescribing link workers; physician associates; first contact physiotherapists; and first contact community paramedics.
Expectation Vs reality
NHS England hopes that PCNs will help with the current workforce issues by employing professionals other than GPs. The hope is that extra staff working alongside GPs, such as pharmacists, physiotherapists and physician associates will help to take the pressure off. It is also hoped that the formation of PCNs will improve the coordination between primary, community and secondary care and help with improvements in population health.
Many GPs believe NHS England’s expectations of the new plans are simply unrealistic as they do not have the capacity or funding to deliver extra work. 7000 new GPs are needed, but the government has only promised a maximum of 6000, and mental health staff and district nurses numbers have fallen in recent years too.
Funding is not shared fairly, so GP services in poorer areas are struggling more. The Health Foundation has criticised the size of the funding settlement and the weighting system, arguing that:
“networks servicing populations with the greatest needs will continue to do so with disproportionately fewer resources.”
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