What is effective Primary Care Network (PCN) governance? That’s never a straightforward question and it’s probably more difficult now than it’s ever been.
I’ve seen examples recently where debates and comments regarding how PCNs are run and the best way to do things have spilled over onto social media, which is never ideal.
From my perspective, there are some really simple, straightforward steps that networks can take to protect themselves, to protect their members and to ensure the smooth running of a PCN.
If a GP walks away, what if you don’t like the new provider?
Let’s say for example that a local general practice has decided it doesn’t want to continue to deliver its GMS contract. It’s handed the contract back to the commissioner and declared: “We’re leaving in three months, you need to find a new provider.” You can read my blog here on what to do if your PCN is not the right fit for you.
That scenario causes a lot of consternation at network level, because they don’t know who they’re getting. They don’t know who the new provider is going to be and whether or not they’ll fit in and get on with them. This can lead to what I can only describe as nonsense on Twitter and other social media platforms, with negative comments about the situation reflecting badly on the PCN.
The easiest way to prevent an issue like that is to deal with it before it happens. So in the event of a practice being taken over by a completely new provider, you can include a clause in your PCN schedules obliging that practice to resign from the network.
It can apply to rejoin, but by then the PCN has had a chance to do its homework on the new provider and the network has the power rather than being forced to embrace whoever is coming in.
It’s the same with a legal entity, lawyers would be able to craft clauses to the same effect around who can hold shares and the process for a practice leaving and being required to reapply to join.
When there’s squabbling, the network is not working properly
So the departure of a provider is something that can be dealt with – but not if you leave it until it actually happens.
Pre-planning is always good, the process outlined above is something I’ve recommended and helped to implement across my 18 years in consultancy, it’s simple, and it works with any network.
The other day I was talking to a lawyer who I’ve come across in my work over the years, and they are starting to see a lot of networks go to them because they’ve got internal disputes and wrangling between the member practices.
When it gets to that stage, the network is not really functioning properly, and problems are not being addressed.
Again, I’ve supported those with disputes many times with networks where the membership are not getting along as they should, and I’ve helped them find a resolution so they can continue moving forward. It usually boils down to poor governance that needs tightening up to everyone’s benefit.
Forced allocations can kill a network
But my lawyer friend and I were talking about a slightly different subject – orphan practices. These are practices that want to be members of a PCN but can’t get in.
Orphan practices are not direct problems for networks but they are direct problems for Integrated Care Boards (ICB) because they have to make sure that every practice that wants to be in a network is actually part of one.
The issue here is forced allocation. An ICB has the power to force a network to accept a practice even if it doesn’t want it. This situation has huge potential ramifications.
I’m aware of more than one network threatened with the forced allocation of a practice which has simply refused and insisted its members will just leave to join other local networks – thereby dissolving the PCN – rather than accept the practice.
So this one needs some careful handling. But again it comes down to good governance. The process for assessing an application to join the network should be well-defined at the outset. What’s the process? How do we then make a decision?
It should absolutely not be left to the point at which a practice is foisted on a network, and panic suddenly breaks out because there’s no process to fall back on.
This is a business and needs to be treated as such
At the end of the day, general practice must be treated as a business. That’s what it is, whether or not we’re happy to admit that.
The networks are part of that business, and so having really good governance to run your network is absolutely essential. Because when it goes wrong, it’s then too late to fix it, you’re then working with whatever you’ve got in place.
I, therefore, advise all PCNs to have their governance structures under constant review. Ask yourself if your governance is fit for purpose and is working to your benefit.
Things will go wrong, it’s just inevitable. We’ve got 1,307 networks across the country, they won’t all run smoothly. And what you want to know is when things don’t work, or you have a falling out, there’s a process in place that is robust, fair and causes minimum disruption.
Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive. If you want to know how to double your revenue and reduce the overwhelm, Scott can share these processes with you too. Schedule a call today.