In recent weeks following the Primary care estates funding update there have been two other publications from the centre that could shape the future of healthcare in England, but they raise more questions than answers.
First is the Model ICB Blueprint, this reconfigures the functions of Integrated Care Boards (ICBs) divesting those deemed non-core to providers at about 50% of their current cost within a new ICB budget of £18.76 per patient.
This potential list of 18 options includes medicines optimisation, pathways and service development, workforce development and training, estates and digital transformation and primary care IT support.
Specifically, and especially important for PCNs and GPs, the proposal mentions moving primary care operations and transformation to neighbourhood providers without clearly defining what this may look like.
The stated primary purpose of this transformation is to create left shift of resources to prevention and have a data driven approach to population health through digital technology.
However, this would be a seismic change in how primary care is commissioned as well as the supporting structures that underpins its success. It threatens a significant loss of autonomy and potential vertical integration by stealth which could lead to an overall detriment in care by reducing some of the flexibility current contracting mechanisms allow to meet patient need.
If these functions are moved to larger acute and community providers, notwithstanding the question mark over the ability to deliver them in the reduced cost envelope, there is a significant risk that the productivity gains from left shift required may not be met, leading to further dilution of resources to frontline primary care.
Historically, this has been because (understandably) these large providers focus on the immediate viability of their services before considering moving out resources to the community.
There would need to be a clear mandate and directive that is enforceable to enable this as we have been trying, unsuccessfully, for over a decade to do this.
The divestiture of ICB functions to trusts would also raise question marks on the future of place based primary care organisations such as GP Federations and their continued viability.
The second document from the BMA on The Value of a GP illustrates with evidence why we are the most cost efficient and productive part of the healthcare system and properly resourced can achieve the ambitions of Lord Darzi in moving care to the community.
Pulse PCN has shared numerous examples of innovation of PCNs in this space over the last few years. With the unique relationship we have with our patients reinforced by better continuity, surely Primary Care must be the lead provider within Neighbourhoods and deliver most if not all the devolved functions from ICBs?
This could be through regional Primary Care Collaboratives, GP Federations and PCNs depending on local dynamics and need not impact GPs who just want to see patients.
This would lead to the best chance of success for the goals of health secretary Wes Streeting and his government.
Conversely, if Primary Care is not at the forefront of this transformation, the chances of failure are significant.
It feels like we are once again at a crossroads during a system configuration but this time with a lot more skin in the game and this time we need to be more proactive in becoming the centre of change.
Dr Sarit Ghosh is clinical director of Enfield Unity PCN, north London, on Pulse PCN's editorial board, lead partner at Medicus Health Partners and co-chair of Enfield GP Federation.