Everything you ever wanted to know about PCNs

They were introduced in the NHS Long Term Plan, published in January 2019, and they bring together primary care and community care teams at a local level to improve services for patients. They cover the NHS in England.

Well, yes, integration of primary and community care has been on the NHS agenda for a long time, and using primary care as the basic building block for the NHS has been around even longer.

No, it’s really not. PCNs  are about service provision, not about commissioning or purchasing of services.

The PCNs are to be based on footprints of between 30,000 and 50,000 patients. The lower limit would be flexed only in areas of extreme rurality, but the upper limit appears to be open to more flexibility. These footprints will nearly always be geographical, but in some cases non-geographic PCNs may be allowed ( i.e. like-minded practices, or those linked through business) and it may be possible for GP practices to be in more than one PCN.

Yes, pretty much so, as being part of one will link to practice payments through the new GP contract. It’s not yet clear, however, what will happen if GPs don’t want to actively run their local PCN. One local PCN might take over another, for example. The PCNs will be funded through a DES payment, which will include an element towards the costs of running the PCN organisation.

They have! PCN groupings and clinical leaders were in place by June 2019 and the first funding started to flow to PCNs that year.

PCNs will be composed of general practice and community staff. They will receive specific funding for clinical pharmacists and social prescribing link workers in 2019-20, then for physician associates and first contact physiotherapists in 2020-21, then for community paramedics in 2021-22.

That’s good news, as networking will be vital for a PCN to be successful, but not every local area has a history of working well together. Some people will find this kind of organisation very difficult to work in.

We think that a network of practice managers, sharing information and supporting each other, would be a real asset to a fledgling PCN.

In part, that might depend on what you can give to the PCN. It’s an opportunity for you and your profession to have a role in how local services might be improved or reshaped. Could your role be expanded? Can you see an unmet need in your patients? Can you remove a bottleneck in the patient journey? Can you talk to your patients about their experiences of receiving care locally?

We know from the Kings Fund study of similar organisations in Wales, Scotland and Northern Ireland, that developing trust and good relationships is key to success, as is having a clear focus on the organisation’s objectives and the key reasons for its parts to collaborate. So, in short, they will need to know their population, build effective networks, map and understand local services, appoint local leaders, decide local priorities, and manage multi-disciplinary teams. Put like that, it could be a tall order… At the moment it looks like NHS England is taking a sensible approach and not expecting to see all PCNs doing everything immediately. Priorities in 2019-2020 include appointing clinical leaders and getting local networks up and running. The better PCNs should also be making a start with assessing local populations, particularly people with long term conditions who are at risk.

PCNs work in a framework set by other NHS bodies, such as STPs, etc. Its unlikely, for example, that a PCN could choose not to pursue a priority set at STP level ( such as improving cancer outcomes, for example) but it should be able to add priorities of its own – for example to improve diabetes services. Some priorities will probably be clinical ( e.g. asthma) but others might be service-related. For example, its widely accepted that patients have problems accessing appointments in general practice. Practices co-operating on a PCN footprint might be able to find a way to improve access. They might be able to find a way to support patients with long term conditions to self-manage by setting up PCN-wide groups. Actions like these might then free up GP time to look after complex patients.

The NHS is under a duty to consult and involve patients in their care, both individually and collectively, and PCNs could be the perfect vehicle for doing that. Certainly any PCN choosing to map service patterns or referral processes would be wise to involve patients or patient groups in that process, as their perspective could prove invaluable.

Almost certainly! The NHS Long Term Plan sets out a vision of PCNs running local heart failure networks, supporting people wearing monitoring equipment, and delivering enhanced care in care homes. We think that NHS England and Public Health England also see a role for PCNs in prevention, too.

Hopefully not – as far as we understand it, PCNs are not going to be statutory bodies, just local aggregations of healthcare professionals. It’s easy to be cynical when faced with another NHS reorganisation, but the scale of PCNS seems about right and this could be a great opportunity for healthcare professionals to come together for the benefit of the communities they know best.

We have a range of tools, workshops, and education courses that can help PCNs grow as organisations and deliver better care. For example, our diabetes profiling tool can help practices get live data about their diabetes patients. We can facilitate a workshop on service and process mapping. We can provide leadership training.