What If Your PCN Is Not Delivering What You Need It To?

We’re at that time of year when GPs, nurses, pharmacists and others start to ask themselves if they are in the right primary care network.

PCNs were formally established across England on July 1 2019. They were reshuffled in March 2020, again in 2021 and again in 2022. I’ve no doubt this year some networks will go through that change process again.

We started with just over 1,200 networks and now have just over 1,300. At the risk of being shot down, I think we’ve topped out – I think we’re more likely to see networks merging and becoming more extensive. I handled one a few months ago, where three networks of around 35,000 patients each came together to become one big network of just over 100,000 patients.

But what do you do if your PCN isn’t working for you anymore? What if you think it could be delivering more? And what if working in your current PCN feels tortuous?

A reluctant leader will likely miss out on the opportunities available to a PCN

One recurring issue that really does cause problems for PCNs is when their Clinical Director decides they don’t want to do the job anymore. Through my work and some of the workshops I’ve delivered recently, I’ve become aware that many clinical directors are in post because no-one else wanted the job. They’re not there because they want to be – they’re there because they have to be.

For me, that’s not a recipe for a network that will thrive, grow and grab hold of the requirements. Where you have a reluctant leader, you’re almost certainly missing out on the opportunities that being part of a network provides.

Another factor that can contribute to a non-productive network environment is ignoring the problems. If you look to the future now and you feel the network is not working for you as a practice, that feeling will never go away on its own. Sweeping things under the carpet eventually means you’ll trip over the lump in the carpet.

If you are in that headspace, looking around at your peers in the network and thinking that this isn’t delivering what you need, stepping back and looking at what a fresh start might do for you might help.

Work your way out of the problem – or go with the flow

I’ve supported multiple networks that have faced this challenge, and the first thing we asked was what needs to stay after two-and-a-half, almost three, years of doing this. What would we want to let go of? And what needs to change to help us drive forward and properly define what type of organisation we want to be? How do the really successful PCNs make it work?

How can we make progress? We can do it as a highly motivated primary care network that grabs the opportunities and sees the investment that’s going into the networks. (We could debate the rights and wrongs of whether it should be core contract or network, but we are where NHS England has put us – PCNs are part of the landscape, and they are here to stay. The soundings I’m getting indicate that NHS England are already working on the 2024-29 contracts.)

Or we can get by doing the bare minimum – there are steps and processes that can be put in place to enable that.

As with any business, there’s a life cycle with a PCN. They go through the start-up phase with their big idea (in the case of PCNs, they didn’t have the idea per se, it was thrust upon general practice). For many of the networks, there was then a phase of rapid growth.

Some are really beginning to mature. They have a solid, long-term future ahead in the way they work, the way they deliver and the way they engage with – and are accountable to – each other.

Then there are a few that clearly are not maturing after their initial phase. They haven’t kicked on.

Some are in outright decline and require action.

In that case, do you go through a process of rebirth or accept that it’s over? Watch the network come apart and let practices find other networks to join?

How do you revive a flailing PCN?

In either case, death or rebirth, you need a solution. How will you do it? Who will be responsible and for what? They have to nail this down to move forward.

It boils down to leaders and followers. Is maintaining the primary care network as it stands still the right thing to do? If not, will you go along with the status quo or fight to change things?

When it clearly isn’t working, I advise PCNs to stop and admit defeat. It’s much better to form a new network with different partners or join another network. At least you’re tackling the issue.

So, let’s look again at the fact we’ve gone from 1,200 PCNs to 1,300. Going forward, I believe we’ll see the number of networks contract as they form bigger entities of 70,000-100,000 patients simply because there are not enough people on the ground to fill those leadership roles.

We’re already seeing some bigger PCNs finding it easier to function, but the move towards larger networks requires practices that are prepared to be proactive to succeed.

If you need support to reformat your network or are wondering how to continue as your current network, get in touch. I’d be delighted to help. Read more here about my three step process for building the PCN you’ve always dreamed about.

Fed up of pulling in different directions? I help GPs, PCNs, GP federations, and Integrated Care Systems tackle their communication and process challenges to build sustainable and resilient practices that produce better outcomes for all. If you’d like to find out more, schedule a call today.