Intended for healthcare professionals

Opinion Primary Colour

Helen Salisbury: Primary care networks in a tangle

BMJ 2024; 384 doi: (Published 23 January 2024) Cite this as: BMJ 2024;384:q170
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter @HelenRSalisbury

When primary care networks (PCNs) were first set up in 2019 they were envisaged as groups of general practices joining together to provide and develop services for a local population. Each PCN is allocated a budget that it can spend on additional staff—pharmacists, paramedics, physiotherapists, and others (but not doctors or nurses)—and the size of that budget depends on the number of patients in the PCN.

In some cases the additional staff work across the PCN providing services for patients of all the practices; in others, each surgery hires its own. There’s no stipulation that the practices should be adjacent, only that they should serve a population of 30 000 to 50 000 patients. This could be one “super practice” but is more commonly three to six practices (our PCN currently has five, but two are merging very soon). This has led to some slightly unlikely geographical groupings in our county, and the situation has been made more complicated by a number of recent mergers.

In the past two years at least five local partnerships have been unable to continue as independent businesses because of difficulties in finding staff and paying them. In some cases smaller practices have merged, joining together and benefiting equally from the resulting resilience and economies of scale. In others it’s more a case of one practice taking over the contract of a struggling practice and providing services for its patients.

Complications arise when a practice merges with another from a different PCN. In one case a practice hadn’t hired any “additional roles” staff, and all the money in the budget was spent by another practice in the original PCN. Now that other practice doesn’t want to lose the staff embedded in its service, but the other practices in the new PCN justifiably argue that, if their patient population is growing by 10 000, they should receive the funding that goes with them. It seems that this instability wasn’t foreseen when PCNs were first dreamt up, and now the integrated care board is left with the headache of having to adjudicate.

From this GP’s perspective, the whole PCN project is a bit of a damp squib, with little in the way of new developments locally. Many of us are collaborating only as far as the letter of the PCN contract demands, and, although we appreciate the extra staff, we have no time or energy to develop new services and no particular appetite for working more closely together. If the money for PCNs had been invested in core general practice to be spent more flexibly, it’s likely that fewer practices would be going out of business, causing heartache and disruption to doctors and patients alike.

And what will happen to PCNs this year? The new contract will come into force on 1 April, but we’ve not yet had sight of it. GPs are famed for their capacity to tolerate clinical uncertainty, but in the realm of business it’s less comfortable. Right now, we’d really like to be reassured that we’ll continue to be reimbursed for the staff we’ve employed with PCN funds and to know what new strings will be attached.