England’s smallest PCN gets a green light

A rural Cumbrian GP practice with 8,000 patients has been given the go ahead to become its own PCN due to geographical isolation and population demographics.

Waterloo House Surgery in Millom will be the smallest PCN in England, followed by Marsh PCN in Kent which has 17,000 patients.

Lancashire and South Cumbria Integrated Care Board (ICB) granted permission for the change due to its ‘unique geography’, despite it not meeting the requirements set out in the DES, as it will only consist of one practice and has a list size below 30,000.

Formerly part of Barrow and Millom PCN, the practice is run by Cumbria Health with a total list size of 7,955 patients.

The ICB acknowledged the decision could be seen to be setting a precedent to allow single-practice PCNs, but said the geography and demographics of the area had made it difficult for its former PCN to deliver the requirements of the DES.

It also suggested the risks are ‘further mitigated by the contract being held by a large-scale provider’, Cumbria Health.

In a paper evaluating the change, the ICB said it would mean services could be delivered ‘to meet the needs of the Millom population’.

It said: ‘Millom is a small, isolated town approximately 45 minutes away from the centre of Barrow, where the other PCN’s practices are located.

‘Given the geographical isolation and the different population demographics it has been difficult for the Barrow and Millom PCN to design and mobilise services that meet the needs of the patient population across the PCN footprint.’

The ICB also acknowledged that the new PCN would not meet the DES requirements but said the service recognises there will be ‘exceptionality’ to these, particularly where there is a low population density across a rural area.

Letters of support for the change have been written by both a patient participation group for Waterloo House and the town board chair for Millom, citing the benefits they see for the local population.

A spokesperson for Lancashire and South Cumbria ICB said: ‘Now that Millom is the only practice within the ICB that is located within the boundaries of the recently-formed Cumberland Council, this change allows for PCN services to be fully aligned with the local authority footprint, meeting the local strategic needs and improving the ease of access to services for patients.’

Medical accountant Andy Pow said the change would present challenges for the existing PCN through ‘lost funding and also the need to review existing ARRS staff roles especially where staff provided services to the new PCN patients’.

He added that it could set a precedent for practices and PCNs in rural areas with similar geographical issues.

‘This could allow practices to take greater control over their PCN budgets which many would wish to do,’ he said.