So, what now for PCNs?

At the special conference of LMCs on 11th March, an overwhelming majority (3 to 2) voted in favour of resolutions, including that the new PCN DES is:

  • a “Trojan horse to transfer work from secondary care to primary care”; and that
  • this strategy poses an existential threat to the independent contractor model

Could this be the end of PCNs?

The 5 Year Forward View, the Long-Term Plan and virtually all Sustainability and Transformation Plans talk of shifting the burden of care from secondary to primary care, so this is hardly a surprise to GPs, but does it present an existential threat to PCNs?

The NHSE publication “GP participation in an Integrated Care Provider” (August 2019) refreshed the Multi-Speciality Community Provider (MCP) model as an Integrated Care Provider (ICP) system, with its “fully integrated” option that sees primary care surrendering its GMS contracts in place of a single contract for all out of hospital care.

Also, the principal purpose of “NHS’s recommendations to Government and Parliament for an NHS Bill” (September 2019) was “to free up different parts of the NHS to work together and with partners more easily…..(to) speed implementation of the Long Term Plan”. Two interesting proposals in this draft Bill are the removal of the commissioning of NHS healthcare services from procurement regulations and the repeal of the Secretary of State’s power to establish new NHS trusts, to support the creation of ICPs. So, in this, you can see the possibility of a new NHS trust (a Primary Care Trust?) being created as the organisation into which primary, community, mental health and other support services are integrated.

On that basis, it may be thought of as an existential threat to PCNs and the independent contractor model more generally in the long term.

The more immediate frustration and concern raised at the LMCs’ meeting does not derive from these wider threats to general practice but rather the way and speed at which PCNs have been implemented.

Many of the implications and effects of the PCN model are only now surfacing, and these include taxation (including VAT in particular), employment of the clinical pharmacists, social prescribing link workers, clinical directors and others (are they employees or self-employed, who should employ / engage them, how the risks and costs are to be shared, the tax implications, etc) and gaining access to the NHS Pension Scheme for these employees / appointees. At the conference this led for calls for NHSE to fund tax advice for PCNs and for the BMA to explain what discussions (if any) it had with HMRC before agreeing the network contract DES.

As a result, GPs are trying to match an increased workload and a new and different way of working with a lack of funding and a chronic shortage of staff to fill the new roles required of PCNs. This also explains the results of a recent Pulse investigation (Pulse – March 2020) that found that only half of PCNs were able to recruit a clinical pharmacist last year.

These are the real issues affecting PCNs and only if these are resolved satisfactorily will PCNs be an appropriate vehicle for the integration of primary care.

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