Grand ambitions: PCNs need local autonomy

Professor Aruna Garcea says PCNs need more local autonomy while also retaining a core national focus 

The past few months have been quietly meaningful for primary care. Our NHS Confederation North Star report,¹ which sets out our vision and ambitions for at-scale general practice and primary care, has been published, and negotiations on the new GP contract and PCN DES for 2024/25 are under way. 

The health needs of our population are becoming increasingly complex and demand is rising. Providers have undergone a rapid evolution, yet this does not appear to be enough. 

We know we need greater investment in primary care. The first four years of PCNs have seen an increase in integration, at-scale prevention including vaccinations, and the introduction of a single point of access to a range of practitioners through the alternative roles reimbursement scheme (ARRS), which has proved a real opportunity to do things differently and enabled patients to be seen by the right professional at the right time. 

But to continue this evolution, it is essential to follow the principles of the Fuller Stocktake – personalised care for those who need it most delivered through a joined-up approach to prevention and access. Our vision builds on these foundations, through the creation of integrated neighbourhood teams (INTs), which draw together the full range of primary care providers, in addition to local authority, voluntary, community and social enterprise (VSCE) organisations and community and social care. 

Primary care is uniquely placed to lead the development of INTs. It embodies a culture of cradle-to-grave care, relational continuity, generalist expertise and multidisciplinary teamworking, all of which will be central to INTs. Our objective is to enhance, transform and innovate across primary care, ensuring its readiness to fulfil expectations of INTs and at place and system level.

As well as our North Star report, negotiations on the new GP contract and PCN DES are taking place between NHS England and the BMA. Our primary care network at the NHS Confederation engaged with its members over the summer, ahead of contract negotiations, and has made a series of recommendations² that must be central to the contract if the potential of primary care at scale is to be realised. 

This can be done by giving more local autonomy to services while retaining a core national focus on areas of high impact, as well as providing continuity and assurance to providers with a clear, concise long-term vision. There also needs to be greater flexibility in the use of ARRS funding to meet the needs of local populations and make primary care a more attractive place to work. PCN leaders also told us that both the GP contract and PCN DES should rise annually with a new pay uplift clause.

Our vision of the future of primary care is one that evolves and embraces new technologies, staff roles and clinical care pathways in a sustainable way while retaining the ethos of traditional general practice. With these suggestions implemented, primary care can have a brighter, resilient future.

Professor Aruna Garcea is clinical director for Leicester City and Universities PCN and chair of the NHS Confederation’s PCN advisory group. Read more of her articles here.