The evolution of PCNs has transformed the health care landscape, creating an ecosystem of service providers, technology providers, and specialty consulting. While this transformation has brought invaluable support to practices and networks, we are now at a critical juncture where funding pressures threaten not just PCNs and general practices, but the entire infrastructure that has grown up around them.

The expanding ecosystem

Since their introduction, NCPs have catalyzed the emergence of a diverse support network. This expansion was both necessary and logical – networks faced the dual challenge of providing more services while facing capacity constraints. In response, a number of organizations have sprung up to:

• Increase productivity through technological innovation
• Provide specialist expertise in financial management, legal compliance and quality assurance
• Supports workforce development and training
• Provide back-office functions and administrative support

Even NCPs and federations recognized opportunities to commercialize their innovations by sharing successful solutions with peers. This organic growth has created a symbiotic relationship between the networks and their providers, with both sides building on the success of the other.

The funding conundrum

The sustainability of this ecosystem depends primarily on two funding streams: PCN core funding and the Additional Roles Reimbursement Scheme (ARRS). However, this financial foundation is showing signs of strain, complicated by:

1. The “use it or lose it” funding model.
2. Finding funding to supplement ARRS
3. The unintended consequences of devolution of funding to practices

1.The “Use it or lose it” dilemma.

Networks must either use their full funding allocation during the financial year or risk losing it entirely. This creates pressure to make spending decisions quickly, sometimes at the expense of strategic planning.

In other cases, networks can be criticized for not spending the money, despite a key reason being their inability to reach a consensus on its use due to constraints around them or lack of certainty about the future.

2. ARRS completion challenge

While the scheme provides funding for additional roles and networks recognize the potential value of certain ARRS eligible services, many find themselves unable to afford the additional funding required from their own resources. This results in valuable services going unused, despite being theoretically available, and frustration builds among practices who see valuable support services becoming increasingly unaffordable or not value for money.

3. The challenge of devolution of practice

While transferring funds to practices helps networks spend their allocation, it has unintended consequences:

• Variation in how roles are used
• Different terms and conditions of employment leading to recruitment and retention issues
• Increased competition between practices
• Fragmented induction, training, support and supervision
• Compromised financial governance
• Introducing the work of silos
• Fractional appointments difficult to recruit for small-list practices
• Risk of unmet DES requirements
• Making irreversible decisions
• Loss of network identity and purpose

Where do we go from here?

At the local level;

• NCPs and providers must be transparent about costs and potential savings, balancing the long term with the short term.
• Be prepared to adapt as the needs of the network evolve – this may mean doing things differently, which can be painful in the short term.

On a broader level:

The Labor Government, NHS England and we as the PCN community not only need to think carefully about how we protect GPs as businesses and expand the ARRS-funded GP workforce, but also the cottage industry that supports it – or are we at risk of watching the slow collapse of a support structure that took years to build?

Tara Humphrey is CEO of THC Primary Care, which provides middle management training to PCN leaders and has supported over 120 PCNs.