Primary care networks are about much more than general practice

Primary care networks are at the centre of the NHS long-term plan. The new GP contract, ratified at the NHS England Board meeting on 31 January, begins to give more detail about what exactly they are. It is becoming clear that this new three letter acronym will have major ramifications for the delivery of health and care services in England.

The new GP contract is a promising early sign that the government and NHS England are making good on the commitments in the NHS long-term plan to shift resources to primary and community care. The contract includes a substantial funding boost for general practice, but the new money comes with strings attached.

Practices will be required to come together in geographical networks covering populations of approximately 30-50,000 patients to share staff and services. Though they are not statutory bodies, significant amounts of new money will be channelled through PCNs. Alongside the new contract, NHS England announced that PCNs will employ an “army” of physiotherapists, paramedics and pharmacists.

Integrated services

It is striking just how radical a change this is. According to the long-term plan, the aim is to create fully integrated community-based health services for the first time since the NHS was established. There’s not much we would criticise about the ambition to integrate services around the GP registered list. But in reading the detail of the contract, it becomes clear that PCNs will have implications way beyond general practice.

For PCNs to deliver truly integrated care, they will need to be primary and community care networks. The long-term plan recognises this, indicating that as well as GPs, neighbourhood teams will include staff such as pharmacists, district nurses, community geriatricians, dementia workers and allied health professionals, in addition to staff working in social care and the voluntary sector.

The experience of joint working from the Primary Care Home sites, vanguards, integrated care systems and others highlights that collaboration and team working doesn’t just happen magically. It requires careful implementation, relationship building, and trust.

The impact of this is potentially enormous. Existing community providers will be required to configure their services, and perhaps their strategic plans, to fit with PCN footprints, while community mental health teams will be supported to ”move towards a new place-based, multidisciplinary service across health and social care aligned with primary care networks.”

For very large providers, particularly those which don’t have neatly adjoining geographic boundaries, this could prove challenging. Our work on innovative models of general practice found that co-location is often a key element of the kind of multidisciplinary team working required of primary care networks.

However, this is often difficult to achieve, not least due to constraints on available space. It also needs to be implemented with care to avoid losing the benefits that larger specialist teams can offer, including professional supervision and development support.

Integrated community services of course go far beyond health, but there isn’t a great deal of clarity in the GP contract about how PCNs might engage with the voluntary sector, local authority, social care services or public health. Primary care networks configured around neighbourhoods may offer the opportunity to realise the population health-focused approach that we and others have been arguing for but engaging these other services will be critical.

Primary care networks hold important promise, but the scale and complexity of the implementation challenge should not be underestimated. The experience of joint working from the Primary Care Home sites, vanguards, integrated care systems and others highlights that collaboration and team working doesn’t just happen magically.

It requires careful implementation, relationship building, and trust. This takes time and is difficult to centrally mandate, particularly to the timescales required here. It is encouraging that primary care networks are set to receive significant support to facilitate their development.

If networks are to achieve the ambitions set for them, their development will need to be seen through a broader lens than general practice, involving other providers of community-based services. As GPs scramble to meet the 15 May deadline to agree the makeup of their PCN, it is critical for community and mental health providers, voluntary sector providers, social services and public health to be engaged in these discussions right at the outset.