Hand PCNs control of primary care infrastructure funding, says RCGP

speaking to GPonline‘s Talking General Practice podcast Professor Martin Marshall said it was essential that PCNs were properly resourced if they were to thrive under NHS England’s new organizational structure and deliver improvements for general practice.

‘The problem with PCNs is that much is being expected of them when they’re very immature organizations in most cases – and when they certainly haven’t got adequate funding to make them work effectively,’ Professor Marshall said.

‘If PCNs are the voice of general practice within integrated care systems (ICSs), we’re asking an awful lot of them in a very short period of time, and that’s the concern that the college has expressed for a long period of time.

‘It’s one of the reasons why we’re saying as CCGs are abolished, then a lot of the infrastructure funding that goes into CCGs to support primary care needs to now go into those PCNs. It mustn’t be absorbed into the wider system. We’ve got to make sure that PCNs are properly resourced in terms of management capacity, HR capacity, informatics – all of the elements that make modern organization work – and we need to support them while they mature.’

Talking General Practice podcast
Listen to the interview with Professor Martin Marshall in our podcast here. Or search for ‘Talking General Practice’ on your podcast platform.

Workload pressures

Earlier this week the college launched its report ‘Fit for the Future: a new plan for GPs and their patients’, which sets out steps that should be taken to address the current crisis in general practice. One of its recommendations is that PCNs should be given additional funding of at least £100m per year to help practices work at scale and implement new ways of working.

Professor Marshall also told Talking General Practice that if PCNs were to succeed, NHS England must not see them as a ‘vehicle for delivering more work’ in general practice.

A recent poll by GPonline found that over three-quarters of GPs in England believe that being part of a PCN has added to practice workload. However Professor Marshall said that adding more work into general practice, whether via PCNs or directly to practices, ‘very clearly isn’t going to work’.

‘General practice is beyond the limits of its capability to deliver a high quality service – even at times a safe service. And just pouring more work into general practice, whether it be through practices or PCNs simply doesn’t make sense. [The college] has consistently been making the point to NHS England and to the DHSC,” he said.

‘You need to make sure that all the resources that go into PCNs are supporting practices to do the right thing, not adding to workload.’

Professor Marshall also said that, while he was ‘not naive’ about the difference ICSs would make, they were the ‘right way forward’ and the college would be supporting them and not ‘complain on the sidelines’.

integrated care

He said: ‘Is there a lot of fragmentation in the NHS? Yes. Is that fragmentation bad for patients, bad for commissioners and a waste of taxpayers money? Yes. So let’s engage with ICSs and help them to work as effectively as possible.

‘If ICSs are the vehicle that allow the 42 localities across the country to say “the way to deliver better health outcomes is to invest a higher proportion of our income in primary care services”, that’s a really good thing. And it is ICSs that will make those decisions at local level. Government has patently failed to do that. And let’s see what can happen at a local level. So we believe that, at least in principle, ICSs are a reasonable way forward.’

Alongside further funding for networks, the RCGP Fit for the Future report also called for a review of GP contract arrangements and better co-ordination with secondary care to cut bureaucracy, better IT and an 11% share of the overall NHS budget for general practice.

Polling by the college suggests that general practice faces a ‘mass exodus’ of doctors over the next five years, with almost 19,000 GPs and trainees set to quit unless steps are urgently taken to tackle the workforce and workload crises.

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