Doctors attending the British Medical Association’s (BMA) annual representative meeting last month (June 28) voted in favour of a motion asking the BMA to organise GP practices’ withdrawal from primary care networks (PCNs) by 2023. 

 

The motion, passed in full, also called for PCN funding to be moved into the core GP contract, with 64% voting in favour.

Dr Kieran Sharrock, deputy chair of England’s GP committee at the BMA, said the result indicated “there are ever-growing concerns about how well PCNs are actually working, and whether practices can provide the safe, quality care they want for their patients within the constraints of the current NHS system”. 

“It’s not currently clear how many practices would withdraw from their PCN,” he said, adding that the BMA would “work out what ongoing support would be needed for any practice that does choose to withdraw”. 

C+D spoke to different LPC chiefs about their thoughts on the matter. While most seemed unsurprised at the move, some doubted it would go any further.  

Pharmacists would not miss PCNs 

 

Raj Matharu, chief officer for both Bexley, Bromley and Greenwich LPC and Lambeth, Southwark and Lewisham LPC, said he was not “at all” surprised to hear of GPs' motion to withdraw from PCNs.

“I'm yet to see a PCN which has lived up to the expectations that NHS England and NHS Improvement had of them,” he explained, adding that “PCNs were never funded to be inclusive”. 

It is “very unlikely” the “rank-and-file community pharmacist [would] miss PCNs”, Mr Matharu stated. 

He described PCNs as a “good concept” gone awry after “not being thought through carefully” and those involved not given “the infrastructure to deliver”. 

Kingston and Richmond LPC chief executive officer Michael Keen echoed Mr Matharu in his lack of surprise. 

“[The] government has for some time now been pushing services” – by for instance encouraging higher flu vaccine uptakes within the Pharmacy Quality Scheme (PQS) – “and communications down the PCN route,” he explained, which has an “impact on general practice and community pharmacy contractors”. 

“PCN clinical directors are complaining of an extremely heavy workload,” Mr Keen added. 

"GPs and pharmacists are not automatons that can take on increasing workloads year-on-year"

While he stated it was “too early” to comment on the impact a GP withdrawal from PCNs would have on community pharmacy, he thought it would lead to “big changes” regarding “the role of community pharmacy PCN lead pharmacists”, who are “overworked”, but receive “derisory” remuneration.

The government must “take note that GPs and pharmacists are not automatons that can take on increasing workloads year-on-year, without adequate funding and staffing”, Mr Keen said. 

 

Read more: DH ‘monitoring’ impact of PCN pharmacist recruitment on community pharmacy

PCNs “unlikely to go anywhere” 

 

Some LPC chiefs, however, seemed doubtful that GP practices exiting PCNs would result in the networks being scrapped in the near future. 

Doncaster, Rotherham and Nottinghamshire LPC chief Nick Hunter, for one, said he could not “see how PCNs would ever be abolished in the next few years”. 

His opinion – “not that of [his] LPC”, he specified – is that GPs’ initial steps in abolishing LPCs at the BMA’s meeting are “smoke and mirrors by a minority”. 

GPs “won’t unilaterally walk away” from PCNs, Mr Hunter predicted, “despite the majority of GPs’ dislike” for them. 

However, “the fragmentation [PCNs] bring wouldn’t be missed by me”, he added. 

 

 

Vote will have little impact 

 

Mohammed Kolia, superintendent at Knights Pharmacy and Dudley LPC chair, thought it unlikely that the BMA’s proposals would “impact the Department of Health and Social Care (DH) strategy in relation to the development of integrated care systems (ICSs) and strengthening of PCNs”. 

Though the DH has recently had a shakeup, with Steve Barclay recently replacing Sajid Javid as health secretary, “we know that [...] the DH was already looking at the next five-year forward plan”. 

“I expect the new health secretary to build on this work with immediacy,” Mr Kolia said. 

In the meantime, he stated, the pharmacy sector has “greater challenges”, such as “the shortage of pharmacists”, “sustainability of business” with “increasing overheads” under the fixed five-year contract, and a “critical acute mental health crisis”, due to the “rise in abuse” pharmacy teams are facing.  

 

Read more: Pharmacist workforce issues drive employment solutions, says NHSE&I boss

PCN funding reform? 

 

Meanwhile, Amit Patel from Pharmacy London said he would personally “welcome any reform to PCN funding”.  

While PCN funding currently “sits within the GP contract, [...] the whole raison d’etre for PCNs are to wrap multi-professional teams around a neighbourhood-sized population”. 

 

"The whole PCN concept needs a rethink – to follow the patient rather than the healthcare practitioner”

Community pharmacy PCN leads are not given the “resources, development or thinking space to deliver on any PCN ambitions above and beyond PQS requirements”, Mr Patel stated, nor are they given enough funding.  

The whole “PCN concept needs a rethink”, he continued, so that it can “follow the patient rather than the healthcare practitioner”.

Mr Patel hopes the BMA vote will act “as a mandate” to do that. 

“We can only deliver this with a contract that benefits all parts of primary care and reduces the elements of competition across the sector,” Mr Patel stated, as current commissioning leads pharmacists to “fight for contracts and for workforce, while the patient is lost in the struggle”. 

 

Meanwhile, The Company Chemists’ Association chief executive Malcolm Harrison said the organisation wanted to see “appropriate funding for all activity across primary care”. 

GPs’ desire to move away from PCNs “highlights the need for meaningful dialogue with policymakers to solve the workforce crisis that primary care faces”.

A DH spokesperson told C+D that the government would increase its investment into PCNs to £2 billion a year by 2024.

Read more: Underappreciated and lonely: the other side of the PCN pharmacist role