Five years after the introduction of PCNs, there are key decisions to be made. Joint working of practices at scale has realised some benefits, as can be seen with the delivery of the COVID vaccination programme, some of the new staff roles that have been introduced and extended and enhanced access coordinated by PCN teams. But there is a reckoning to be had. Funding of core general practice must be addressed with practices warning they are becoming unviable. The vast majority of our GP respondents want to see funding moved back into core general practice while CDs are fairly evenly split on this question. They very specifically want more flexibility on the roles they are able to hire. The sector has been working under intense pressure for too long, and despite the promise that PCNs would free up GP time, this has not happened in any meaningful way.
ARRS is the biggest slice of funding available to PCNs and has led to a mass shift of more than 30,000 staff into primary care. This has had profound implications in a number of ways. While some staff have proved particularly popular, most notably the clinical pharmacist, the mass migration of the profession into this new role had had serious implications for community pharmacy, which is now facing staffing shortages. Physician associates currently make up a relatively small proportion of the ARRS-funded workforce but have caused a great deal of debate about scope and supervision. General practice nurses have raised concerns that their role is being undervalued as a result of ARRS and they are being tasked with supervising staff who are being paid more than them with less experience.
For the next Government, our survey results suggest the priority must not be more re-organisation but to listen to the deep concerns of those working in primary care and to take steps to put general practice on a sustainable and secure footing.
Better pay and improving ambulance response times came up high on our respondents’ lists of priorities. Those working with and in PCNs do not want to see more AI-driven care or the driving forward of integrated neighbourhood teams. Most would also not put scrapping PCNs at the top of the to-do list. Instead, the vast majority want more recruitment of general practice nurses and GPs, a reduction in the elective care backlog, which has a large knock-on impact on demand for general practice, and improved movement between primary and secondary care.
There is clearly also a need for ICBs to do more work on engaging with primary care. Our survey showed a real sense that connections with NHS commissioners have become remote for those working in general practice. The emphasis must be on listening to those who know and understand the needs of their populations the best as well as ensuring that all available funding is used to support the record levels of care they are delivering every day.