The explainer: What are primary care networks?

Primary care networks are being set up to promote integrated care. What will it mean for GPs?

What are they?

PCNs are groups of GP practices working collaboratively in a formalised structure, typically covering a population of 30,000 to 50,000 patients, and combining with other primary and community services and local organisations to ensure an integrated approach to health and care for that population. It is expected that all areas in England will be covered by one by July.

Why are they being established?

The intention behind establishing PCNs is to focus services around local communities, building on local GP practices to help rebuild and reconnect primary healthcare teams across the areas they cover through the network.

The BMA GPs committee negotiated a new directed enhanced service with funding entitlements in this year’s contract to fund PCNs because the ownership for leading local services should sit with GP practices. Only GP practices can set them up. It is hoped they will alleviate workload pressures and allow GPs to concentrate more on the most complex patients.

Aren’t there already networks?

Yes. In fact, most practices in England work in some kind of network. The difference is PCNs have the support and backing of a national contract and formalise the establishment of networks in a consistent way.

Will they offer new services to patients?

Yes. From 2020 there will be the potential for additional funding of new services in line with the aims set out in the NHS Long Term Plan. These include medications review, supporting early cancer diagnosis and cardiovascular disease prevention and diagnosis.

What kind of funding will be available?

There will be payments to practices for engaging with PCNs, and other payments direct to the network as entitlements; some are ringfenced (eg for a clinical lead and a contribution towards new staff costs) while other payments are for networks to decide the use.

How much flexibility will be permitted on the size?

The thinking is that the practitioners involved will still have a reasonable chance of knowing the people they are working with, but that PCNs are large enough to have an effect and make economies of scale. However, if practices think they have a good case for forming a larger or smaller network, they should make it to their CCGs (clinical commissioning groups).

Could a large practice be a network in itself?

Yes, particularly those practices which have 30,000 to 50,000 patients and cover multiple sites within a geographical area.

What happens now?

Practices are being urged to talk to their neighbours about forming a network. Local medical committees are in an ideal position to coordinate and mediate where necessary and the BMA will provide advice and guidance. The new PCNs will submit registration information to their CCGs by the middle of May, with CCGs confirming the network coverage by the end of May. They are planned to go live in July.

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The one-stop shop for primary care networks

The publication of the PCN agreement is only a couple of weeks away and colleagues across the country have been sharing their thoughts with us about the challenges and opportunities that PCNs bring to general practice and GPs.  There are still many unanswered questions for colleagues and with any change it is inevitable that there will be concerns about how these changes will impact you personally and where you can get the support you need.

So, here it is – Today, the BMA has launched the support package for setting up PCNs, starting with The primary care handbook, which offers guidance, considerations and options for all PCNs and practices in the country.  The handbook includes detailed guidance on:

  • Governance structures
  • Internal governance and decision making
  • Potential PCN structures and employment options
  • PCN funding
  • PCN future workforce options

This handbook will help you get ready for the roll out of PCNs on 1 July this year.  But this is not the only support the BMA is going to provide for you. Over the coming weeks, we will release a suite of BMA resources, which will provide you with tools, training and support to guide you through the process of setting up a PCN. From July onward, we will be launching a BMA PCN membership offer, providing ongoing support that is tailored for your PCN.

This is a professional package built by the team that negotiated your contract and knows it best. It will include all the support that you need not just for today, but for tomorrow and beyond.

The next step is to read the Primary Care Network Handbook. It may look daunting, but offers everything you need to know before making any decisions on how your PCN is going to shape up.  Get in touch with your LMC to discuss the local challenges that you face. For specialist advice on aspects of how to structure your PCN, get in touch with the BMA.  While the PCN offers you a lot of control and opportunity to transform your practice, you will need the BMA to support you to make the most of the opportunity.

As I’ve said previously, if you haven’t looked through the below documents, please familiarise yourself with what the new contract offers you.

  1. Contractual documents
  2. BMA guidance
  3. PCN Blogs

Richard, Mark, Farah and I will be continuing to do a large number of GPC contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract.  Please do come and attend these and share your thoughts with us.

In the next few weeks, we will add more blogs on the following topics:

  1. Making the most of the funding available for PCNs
  2. PCNs and the LTP
  3. Troubleshooting for PCNs

Get talking with your colleagues around you.  Get talking with your LMC to make sure that you get to lead this journey.  Get in touch with the BMA – the national voice of your PCNs – so that you hit the ground running and make it work for you, your colleagues and your patients.

Krishna Kasaraneni is a member of GPC executive

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Primary care networks (PCNs) and workforce expansion

As the contract roadshows continue, discussions about PCNs and how the new workforce expansion will support GPs and practices are creating much debate.  Naturally, there is a wide range of opinions on this from ‘Haven’t we heard this all before’ to ‘Why are GPs and nurses excluded from the workforce reimbursement’ and also interspersed by others who already work with an expanded workforce team that are concerned that they won’t be able to capitalise on the new opportunities that this offers them.

So, the first point – why are GPs and Nurses excluded from the workforce reimbursement?  Well, to answer that, first and foremost we need to be clear about what the PCN DES is intended to do.  Our vision of the PCN is that it helps expand the workforce team beyond the current numbers.  It is no secret that is the biggest issue in general practice – unless we have more bodies on the ground to help us with the ever-increasing workload, we will not be able to turn the tide.  Added to that, the last thing we want to do is remove GPs and nurses from practices who are the nucleus of general practice to work at a PCN level.  That would be analogous to removing the building block of the foundations to cover the roof – it won’t stay up!

There is no general practice without GPs, nurses and the legions of staff that help us run our practices every day.  The PCN DES is not about substituting them, but is about taking some work off them to make the system more sustainable.

That brings us to the promises that we’ve heard before – the extra 5000 GPs and other commitments.  For the first time in a while, you will see in the contract document that there is an acknowledgement that this target is not that easy to achieve. An honest conversation is the first step in addressing the problem and that is what we have in this deal.  Whilst any target would be ambitious, and the progress would be slow, the fact that we are now working together to make sure that GP practices get the extra support, shows that this is a joint ambition and commitment that underpins this year’s contract deal and one that we will work together to achieve.

What are we aiming for?  We are aiming for every single practice to have a Clinical Pharmacist working for them in the next 5 years as part of the PCN.  We want Physiotherapy Practitioners in every single practice to be the first line of contact for patients for musculoskeletal problems.  We want Physician Associates in practices to support the work GPs are currently doing and take some of the burden off the current workforce.  We want Paramedics to be shared between practices who can assist them with appropriate clinical work in practices and with the home visiting services that they are trained to do.  We want Social Prescribers to assist GP practices with patients who are having to deal with challenges that extend beyond ‘health’.

Will we hit the targets for the workforce expansion in the next 5 years?  That is mostly up to us.  Whilst the policy and political environment is not entirely in our control, the determination and vision to help ourselves is firmly in our control.  Therefore, we will need to try our best to make this work for us.  And remember, we are in control of this.  The Clinical Director role for PCNs is costed on a GP performing the role.  The PCN agreement realigns the narrative of putting clinicians in leadership roles and that is an opportunity to make it work for our practices, our staff and our patients.

As I’ve said previously, if you haven’t looked through the below documents, please familiarise yourself with what the new contract offers you.

  1. Contractual documents
  2. BMA guidance
  3. PCN Blogs:
    Primary Care Networks
    The right structures for PCNs
    LMCs and PCNs

Richard, Mark, Farah and I will be continuing to do a large number of GPC contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract.  Please do come and attend these and share your thoughts with us.

In the next few weeks, we will add more blogs on the following topics:

  1. BMA central support for PCNs
  2. Making the most of the funding available for PCNs
  3. PCNs and the LTP
  4. Troubleshooting for PCNs

So, if I may leave you with Churchill’s quote that was referenced at a GPC meeting recently – “If you are going through hell, keep going”.  That is something every single one of us can relate to in terms of the out of control workload in recent years.  The workforce expansion is our opportunity to address this.

Krishna Kasaraneni is a GPC executive member

Sian HeaphyPrimary care networks (PCNs) and workforce expansion
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Local Medical Committees (LMCs) and primary care networks (PCNs)

The GPC England executive team kicked off the GPC contract roadshows last week and it would be fair to say that interest in the changes this year is significant. And not surprisingly, the topic which generated a lot of discussion has been PCNs. Our webinar last week (for LMCs and GP reps) also featured many questions about PCNs and how LMCs can support practices to engage with the PCN DES and ensure that their areas are covered fully.

Let’s therefore start with what is usually the easiest thing, but unfortunately can often be the most difficult – how do practices work together? Plain and simple, this will be down to local relationships between practices and also between LMCs and the CCGs. Many practices are working successfully in collaborative relationships already, and they have been for years! However, where there are difficulties in agreeing on a working relationship with your colleagues, flag this with the LMC as soon as possible. Just to be clear, there isn’t a magic solution that the LMC has in resolving this. But they are experts in resolving problems and will be happy to work with you to consider what this contract and the PCN DES brings to your practice and to your region and help you find common ground with those around you. LMCs are ideally placed to take up these conversations on behalf of the practices, not just because of the democratic mandate that they have that is recognised in statute, but also because of more than a 100-year history of corporate memory and local knowledge for which there is no substitute.

It may not be easy, and it could mean making some difficult decisions, moving beyond historical differences, and in the interests of your patients, your staff and your practices, starting to work in a way that improves the state of general practice in your area. LMCs, working with CCGs will support you to get there, but the practices have to walk the walk and LMCs are there to help you in the journey – as a confidant, and your ally.

Those of you who are already in collaborative setups in your respective regions, please don’t be led to believe that you have no option but to remain in these setups. The PCN DES is different to what has gone on before and whilst some of these structures may help you realise the benefits of being in a PCN, this is for you as a practice to decide and seek support from your LMC to make sure that you have your say. We are hearing nationally about CCGs trying to support practices do just that in many places. There are however some areas where we are already hearing that some CCGs are dictating terms on what the foot print for PCNs should look like. I would urge you to refer to the guidance before you pay attention to these messages.

  1. Contractual documents
  2. BMA guidance
  3. PCN Blogs

LMCs know how to work well with commissioners and have frequently been in situations where they disagree with them when the commissioners have a different perspective on things. The representative function of the LMCs rely on practices being clear about what they need and work with the LMC to improve general practice locally. This is what we need to build on.

Richard, Mark, Farah and I will be continuing to do a large number of GPC England contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract. Please do come and attend these and share your thoughts with us.

In the next few weeks, we will add more blogs on the following topics:

  1. BMA central support for PCNs
  2. Making the most of the funding available for PCNs
  3. Workforce expansion for PCNs
  4. Troubleshooting for PCNs

So, if I may leave you with one message and one action for this week:

  • Message: LMC is your voice locally.
  • Action: Re-establish contact with your LMC.

Krishna Kasaraneni is a member of GPC executive

Sian HeaphyLocal Medical Committees (LMCs) and primary care networks (PCNs)
read more

Local Medical Committees (LMCs) and primary care networks (PCNs)

The GPC England executive team kicked off the GPC contract roadshows last week and it would be fair to say that interest in the changes this year is significant. And not surprisingly, the topic which generated a lot of discussion has been PCNs. Our webinar last week (for LMCs and GP reps) also featured many questions about PCNs and how LMCs can support practices to engage with the PCN DES and ensure that their areas are covered fully.

Let’s therefore start with what is usually the easiest thing, but unfortunately can often be the most difficult – how do practices work together? Plain and simple, this will be down to local relationships between practices and also between LMCs and the CCGs. Many practices are working successfully in collaborative relationships already, and they have been for years! However, where there are difficulties in agreeing on a working relationship with your colleagues, flag this with the LMC as soon as possible. Just to be clear, there isn’t a magic solution that the LMC has in resolving this. But they are experts in resolving problems and will be happy to work with you to consider what this contract and the PCN DES brings to your practice and to your region and help you find common ground with those around you. LMCs are ideally placed to take up these conversations on behalf of the practices, not just because of the democratic mandate that they have that is recognised in statute, but also because of more than a 100-year history of corporate memory and local knowledge for which there is no substitute.

It may not be easy, and it could mean making some difficult decisions, moving beyond historical differences, and in the interests of your patients, your staff and your practices, starting to work in a way that improves the state of general practice in your area. LMCs, working with CCGs will support you to get there, but the practices have to walk the walk and LMCs are there to help you in the journey – as a confidant, and your ally.

Those of you who are already in collaborative setups in your respective regions, please don’t be led to believe that you have no option but to remain in these setups. The PCN DES is different to what has gone on before and whilst some of these structures may help you realise the benefits of being in a PCN, this is for you as a practice to decide and seek support from your LMC to make sure that you have your say. We are hearing nationally about CCGs trying to support practices do just that in many places. There are however some areas where we are already hearing that some CCGs are dictating terms on what the foot print for PCNs should look like. I would urge you to refer to the guidance before you pay attention to these messages.

  1. Contractual documents
  2. BMA guidance
  3. PCN Blogs

LMCs know how to work well with commissioners and have frequently been in situations where they disagree with them when the commissioners have a different perspective on things. The representative function of the LMCs rely on practices being clear about what they need and work with the LMC to improve general practice locally. This is what we need to build on.

Richard, Mark, Farah and I will be continuing to do a large number of GPC England contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract. Please do come and attend these and share your thoughts with us.

In the next few weeks, we will add more blogs on the following topics:

  1. BMA central support for PCNs
  2. Making the most of the funding available for PCNs
  3. Workforce expansion for PCNs
  4. Troubleshooting for PCNs

So, if I may leave you with one message and one action for this week:

  • Message: LMC is your voice locally.
  • Action: Re-establish contact with your LMC.

Krishna Kasaraneni is a member of GPC executive

Sian HeaphyLocal Medical Committees (LMCs) and primary care networks (PCNs)
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The right structures for primary care networks (PCNs)

A week on from the contract announcement, I am sure colleagues would have been approached by all sorts of organisations offering you help to set up PCNs.  Let me therefore start with the obvious stuff.  The detailed documents and specifications are being worked up at present and will be released once completed.  Therefore, please do not get sucked in by these offers and reach for your wallets because you will be paying for a product that at best doesn’t exist, or at worst is actually not what you need at present.

So, what do you need to consider at this stage with respect to the structures of the PCNs?  The first place to start is to look at the structures that you already operate in, or operate near.  88% of practices already operate as a part of a network of some description.  Acknowledging that these will be at various levels of development and of varying sizes, some of you may decide to continue with the same structures and some will want to reorganise yourselves.  The remaining 12% of practices will be starting from scratch.  If you find yourself in that position, engage with practices around you and start exploring if there is a potential opportunity for you to join a network close to you.  Irrespective of where you find yourself in that spectrum, please familiarise yourself with the following before you take any actions:

  1. Contractual documents
  2. BMA guidance
  3. PCN Blogs

It is natural to have some concerns about what form your PCNs should take and your first port of call after you’ve considered the above three documents is your LMC. Discuss your thoughts about how you see your PCN developing and make your LMC aware of your concerns and potential challenges. Your LMC will be involved in local discussions with the CCG and consider the local GP landscape and represent your thoughts locally to the commissioners.

This brings me on to the different ways you can organise yourself.  There is simply no specified structure, legal or otherwise for the PCN to adopt in order to sign up to the DES.  All that is required is that the member practices meet the network registration requirements.  These were outlined in the contract document, and further detail will be made available to you by the 29th March.  So, if you start having an initial conversation with your surrounding practices now, you will then have a relatively short window (that closes on 15th May) to submit your registrations.

Depending on how PCNs evolve and how they are supported locally by commissioners, different PCNs may take on different forms at various stages of their evolution in the future.  There will be many aspects that will need to be considered as PCNs develop, to make sure the form follows the function of what you are trying to achieve locally. These could be VAT implications, human resources, leadership development for PCNs amongst other things.  The BMA will provide guidance on all these areas and more in the coming weeks, so keep an eye out for more support from us.

Richard, Mark, Farah and I will be doing a large number of GPC contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract.  Please do come and attend these and share your thoughts with us.

In the next few weeks, we will add more blogs on the following topics:

  1. LMCs and PCNs
  2. Making the most of the funding available for PCNs
  3. Workforce expansion for PCNs
  4. Troubleshooting for PCNs

So, if I may leave you with one message – next step is to start thinking about how your PCN could shape up and contact your LMC.

Krishna Kasaraneni is a member of GPC executive

Sian HeaphyThe right structures for primary care networks (PCNs)
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Primary care networks (PCNs)

Cynics like me are I’m sure tired of hearing a new three lettered acronym every year and how it is going to save general practice! So, why then have we negotiated an enhanced service in this year’s contract which features investment to support working in primary care networks? Well, for a multitude of reasons really, and I hope the following explains our thinking.

First and foremost, the way the PCNs have been incorporated into the core general practice contract will give the ownership of ‘working together’ back to GP practices. Just to be clear, PCNs aren’t completely new. 88% of practices in England already work in some kind of network – like neighbourhoods, localities, federations or super-partnerships. The concept is not new, but the support and safeguards are, and that is what will make PCNs different to the previous TLAs.

Only GP practices can set up PCNs. The framework in which the PCNs operate should go some way to help alleviate workload pressures on practices and allow GPs to concentrate on caring for our patients at a local community level. We believe that this should happen with the support and backing of a robust national contract and that is why it is now a directed enhanced service.

PCNs will consist of a grouping of GP practices within a coherent geographical area, typically covering a population of 30-50,000 patients.  Whilst the exact number is not something we should get fixated on, the underlying principle is that they should be small enough to still provide the personal care valued by both patients and practices, for practitioners working within it to have a reasonable chance of knowing the people they are working with, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system. Practices will also have opportunities to collaborate with other local primary and community services as part of PCNs, and build relationships with voluntary, secondary and tertiary services. This gives GPs the opportunity to lead a renewed primary healthcare team.

There is now guaranteed, recurrent, national funding available to PCNs through the enhanced service to expand our workforce and reduce our workload. Commissioners locally are expected to supplement this and it is us, GPs, who will lead the networks to ensure general practice remains at the core of PCNs. Aspects of competition between providers will now be replaced with collaboration.

So, as a GP practice, do you have to be part of a PCN? The short answer is that you do not, in the same way that you do not have to take part in QOF. They are both voluntary. However the opportunities are not only of additional funding to deliver an expanded workforce, but just as importantly the ability to lead and shape community services in your area means this is something we would hope every practice would want to be part of. I would suggest that you consider the information that is available to you and discuss what opportunity this provides your practice and colleagues around you with your LMC. Richard, Mark, Farah and I will be doing GPC contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract. Please do come and attend these and share your thoughts with us.

The BMA’s initial guidance on PCNs can be accessed here. The BMA will continue to provide you with all the necessary national guidance in the coming weeks – please look out for these and discuss these in your LMCs about the local challenges and opportunities this brings you.

In the coming weeks, we will add more blogs on the following topics:

  1. The right structures for PCNs
  2. LMCs and PCNs
  3. Making the most of the funding available for PCNs
  4. Workforce expansion for PCNs
  5. Troubleshooting for PCNs
Sian HeaphyPrimary care networks (PCNs)
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