PCNs, me and the BMA

As the BMA withdraws its backing for PCNs, columnist Dr Sian Stanley stands up for them

I am pro PCNs. Recently we have seen our whole PCN team doing incredible work in increasing awareness of cancer screening, culminating in a Sunday drop-in smear clinic where 45 women attended in one morning, some of whom were overdue or had never had a smear.  

I am pro PCN because I have seen what primary care at scale can do, and because I cannot see how many of our projects could happen without it. 

I know not all PCNs are equal and some are not functioning well. Perhaps this is due to poor leadership or practices not playing nicely. I am genuinely sorry and would love to see all areas unlock the potential from their PCN.

I cast my mind back to May 2019, when our PCN was set up, with very little organisational development money and a vague sense of purpose. This DES I believe was negotiated by the BMA on behalf of its members. The BMA had also negotiated a government indemnity scheme, and those of us who were paying sky-high indemnity costs were delighted to be freed of this enormous burden. I trusted the BMA General Practitioners Committee (GPC) and thought we could make a go of PCNs. They seemed a good idea, although it was clear we would need a lot of support.

I did question why this money was not going into core funding. I had robust debates with colleagues who said if it had, primary care would never change.

In June 2019 I went on a BMA masterclass for PCN clinical directors. We examined the network DES. Many people were worried about how this would work but we came away feeling supported and cared for by the BMA.

In February 2020 I was asked to speak at the BMA PCN conference. My session focused on working with partners. It was like I accidentally produced an integrated neighbourhood team (INT) without knowing what one was.  

The GPC was delighted. It had just negotiated the 100% reimbursement for the additional roles reimbursement scheme (ARRS). It felt wonderful to have the expertise of HMRC, solicitors and the BMA helping us form our networks. Again, some people remained cynical but overall, the feeling was positive.

Fast forward two years. The BMA is trying to remove PCNs altogether. Why? I am not sure. The BMA has been very good to me and I am loyal to those who have helped me, but I am not sure it is representing me at the moment. For a while now it has felt that we are thriving despite the BMA, not because of it.

I would love to see a solution-focused stance on PCNs, where those that are not working are helped to mature and flourish. Those that have become paralysed need support and infrastructure with clearer governance and all the boring things that are necessary to make an organisation function.

There is no doubt that we need more core funding but is the abolition of PCNs the right way to get it? Should we not look into the art of the possible, with funding flowing into practices who work together and produce good outcomes rather than simply good processes?

My story with the BMA has not ended. But I want us to work together to build a brighter future for primary care rather than arguing among ourselves.

As one of my colleagues said to me, ‘If not PCNs, what would we get instead?’

Dr Sian Stanley  is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire