How To Build A PCN

A lot of people in primary care have been asking me about the best way to develop a PCN – Primary Care Networks for those who have been holidaying on the International Space Station or beyond (apply astronauts.nasa.org).

Returning home the other day from the excellent RCGP’s “Creating sustainable General Practice in a disruptive world” national summit, I pondered hearing many questions over the day framed around “how do I build a PCN?” I thought I would break a habit of a lifetime and try and be helpful. I thought to provide a structure that may help people shape their thinking and decision making. So, I thought I would start with the notion of “how to build”.

Sitting on the train, watching the countryside whizz by (yes commuters, LNER trains do really whizz), I thought I would do a web search using just that term. First up was Caitlan Moran’s most excellent novel (and soon to be film I now know) “How to Build a Girl”. If you haven’t read it, the novel deals with reinvention, escape from poverty and is, The Guardian describes, a “quasi cautionary tale”. So that helped me a bit. The follow on “How to build a really solid shed” and “How to build a computer” seemed to offer little to the aspiring PCN builder. But for light relief in a much-troubled world, “How to build a rollback can” is a video worth watching. Well worth a few minutes of your life and please let me know…why?

But that and many other “how to” tips offered nothing. I thought the current guidance we all have on PCNs would yield great insight. Whilst it dealt with some good technical issues for the next year or so, it offered nothing useful in way of decision making other than to stress this sits with GPs. Exactly where it should be you shout. The review document issued on 31st January was quite a good read. I don’t mind admitting that. The review placed the future thinking and structuring primary care in the hands of practices, LMCs, Federations and maybe even CCGs. Whilst CCGs do have a role, according to the current guidance, dare I venture, this is more an arm’s length thing than has previously been the case. Application of guidance is often different in practice.

So, I thought to be helpful I’d draw on all of the above, mix in a jam filling of strategic thinking and add a topping of 30 years practical experience delivering change. You can always ignore it and develop your own framework. And more guidance may emerge of course, dealing with issues arising like contiguousness (yup, a real word).

Right now, I suggest you might want to start by undertaking a little strategic thinking. Not something primary care has been able to do much in the past. I suggest you start thinking short, medium and long term. That means 1 year, 3 years and 5 years in my opinion. That’s about all you can do right now but do keep an eye on the very longer term too. Maybe draw on any random 10-year forward plan you have to hand. Think about how your operating environment will look like in the future, what things are likely be the norm and the things you should start thinking about now so you are ready for the future.

Spoiler alert. Some the following short-term things you might want to consider are clearly PCN-related. Recant regularly the mantra “hard bottom-soft top” in relation to the “30 to 50” sizing. Not everything fits snugly. Typically, that size implies maybe 3 to 6 practices per PCN (not always) and could imply for some, options regarding PCN composition. You will need to consider the “right mix” of practices which could imply hard decision making about who is in your team and who is not. That in turn has implications for neighbouring PCNs which in turn impacts on the way you ICS will work. And another PCN composition issue – which practice will lead? Which is best placed, best and biggest? How will you decide between you those issues? In some areas, the LMC is providing a helping hand, in others, the CCG. But in many, GPs have been left to do that thinking.

Do you know what factors are most important at arriving at a decision? What informs your decision to include one practice over another? What are the “competing” options locally? What local, strategic decisions do you need to consider? Your deliberations and thinking will, of course, consider similarities, commonalities and factors that will make your PCN “whole”. Able to offer joined up thinking and turn this DES-driven renaissance into ground-breaking development for primary care.

Try then thinking about the 3-year horizon. Difficult I know, but necessary. But note that getting year 1 right is the most important thing right now. Think about where PCNs could take you. Think about where your neighbouring PCNs will go based on your short-term decision making. What will they be planning? This is not a competition but is about thinking strategically. And then think abut where your ICS will be in 3 years. Where will the wider health economy be? What’s going on in there?

And then, less easy to complete, think about the same questions in 5 years. You get the idea.

To help, we’ve put together an issues framework that might support decision making. Nothing involving rocket science (you already have the NASA web address) but it may help. Drop me a message and I will send you a PDF copy.

I am sure you will have already started your thinking and discussions. But this may encourage you think a bit more strategically and better inform your collective discussions.