Tom Nolan: Primary care networks are coming

The deadline for GP practices to form primary care networks is almost here, but Tom Nolan finds he still has questions

If there was an award for innovative ways of sending GP partners over the edge, primary care networks (PCNs) would win hands down. It’s not that there’s no competition either. Other entries this year include Capita, the NHS e-referrals service, Babylon, and people who sit in meetings referring to how many different professional hats they wear.

PCNs are what everyone in primary care is talking about. GP practices have until mid-May to form networks of practices, which cover a population of between 30 to 50 000 patients. Over five years, money will be poured into these new organisations, funding an army of social prescribers, pharmacists, physiotherapists, physician associates, and any other non-GP role that NHS England can think of.

PCNs will also, from next year, be asked to sign contracts with other organisations to deliver care together. This is what PCNs are really about, we’re told. Yet nobody has yet been able to tell me who these partner organisations will be and what work we’ll be doing. “Social care, community services, voluntary sector,” I hear people with CCG hats on say, as they mentally flick through their favourite working at scale Powerpoint slidedeck.

Despite not really understanding what this means, forwards we go, considering whether to run our PCNs through federations, set up as a limited company, or through a nominated practice. “You need to have a company,” say those in federation hats, “because of the liabilities.” What liabilities? “For all the staff,” they say. Your head spins: don’t we employ staff already? “And what about VAT?” You look around to see if anyone else is confused, or to see if someone’s filming you—maybe it’s a practical joke. The award winning, Charlie Brooker-esque genius of PCNs is starting to reveal itself. But that’s just the beginning.

The next stage, once you’ve understood that you need to be careful about VAT and liabilities, is to group together. To reach the 30 000 patient mark, for an average sized practice of 9000 patients like ours, this means finding at least three or four other practices to work with. It’s like a cross between Game of Thrones and an episode of Doctors.

In our version of Westeros we have eight kings. Over the past few weeks, we’ve been frantically forming alliances, breaking them, forming new alliances, and stabbing each other in the back. I won’t say it isn’t fun, but we’re only in season one. Before too long I know I’ll either be burnt at the stake or, more likely, turned into a white walker (sessional GP). In the meantime, the clock is ticking, and sign our network agreement we must. We’re in the position where the practices we really want to work with are too far away, the practices we’re happy to work with don’t want to work with each other. As for the practices we have our differences with, but with whom we ought to join for the greater good—over my dead body (that is, the series three finale).  

I know I’m not the only GP partner tearing my hair out right now. I’m not the only one lying in bed at night, running through the options in my head, over and over again, each time coming to the same, inevitable, conclusion: networks are coming. And for that, PCNs deserve an award.

Tom Nolan is a GP partner in South London and associate editor, The BMJ. Twitter

Competing interests: I am a GP partner and elected member of Lambeth Local Medical Committee (LMC).