What will happen to PCNs in 2025?

The future of PCNs seems less certain than ever. They hardly featured in the Darzi report and the new government has rarely referenced them since they came into power (in sharp contrast to their fondness for neighbourhoods!). So, what does the future hold for PCNs? Here are my four predictions for 2025, based not on any inside knowledge but on what we can determine from the clues laid out in the various documents published so far.

1. The PCN DES will shift to become part of locally controlled neighbourhood funds

Let’s be clear on one thing – effective functioning neighbourhoods require GP practices to be working together as a PCN. PCNs are here to stay. They will, however, form part of the new neighbourhoods, but will not be replaced by them. This in turn means the PCN DES will need to continue in some form, along with its associated funding and resources.

The push is for more local flexibility. If locally driven neighbourhoods shaped to the needs of the local population are to work, then a one size fits all PCN model is not what is required. What I would therefore expect is for the national PCN DES to become a local enhanced service with the existing funding and resources as the guaranteed minimum.

As it is highly likely there will be additional funding for neighbourhoods then more resources are likely to be available for PCNs, based on local priorities and incentives for joint working. Where control of this funding sits will be interesting to note, as it could be the ICB, the place-based leadership team or even the neighbourhoods themselves if they form into distinct entities.

2. PCNs will be expected to reconfigure to align with neighbourhoods

The current configuration of PCNs is not going to work for the incoming model of neighbourhoods. While in some areas PCNs align perfectly to the community, mental health and social care teams, in many they do not. I do not think primacy will be given to the existing PCN configuration, but instead there will be some mechanism required, probably financially incentivised, for PCNs to come into line with whatever is deemed the most appropriate local neighbourhood configuration.

3. PCN clinical directors will become part of new neighbourhood leadership teams

The idea of neighbourhoods is that local primary, community, mental health and voluntary organisations will all work effectively together. It therefore seems highly likely that key individuals from each of these teams will form a leadership team for the new neighbourhoods, and so we can expect the PCN clinical director to be the representative of PCN (and by extension general practice) on this leadership team.

The key question is who will lead be the overall leader of the new neighbourhood leadership team. Will it be the PCN clinical director? It is likely to vary from place to place, but one would expect the influence of general practice to be greatest where the CD is able to take on this role.

4. New infrastructure support will be put in place for neighbourhoods that will directly impact PCNs

Both the Fuller Report and the Darzi Report indicated that neighbourhood teams require infrastructure support way beyond that currently received by PCNs. The likelihood is that this will not be developed from scratch, but rather provided by one of the existing at-scale organisations. This could be the local GP federation, but equally could be one of the local NHS providers or even come from the ICB itself.

This infrastructure support will include elements such as data and analytics, HR, estates and management. I don’t think this management function will replace existing PCN management, but rather have more of a role of facilitating and enabling integrated working across the different organisations in the neighbourhood. As this is the NHS, it is inevitable that this neighbourhood ‘support’ function will impact directly on freedom and autonomy that PCNs currently enjoy.

I do not think we will have to wait too long to find out how many of these predictions are going to be accurate. The new NHS 10 year plan is due out in ‘Spring’, and elements of whatever are to be included will need to be built into the GP contract for next year, which means we will know more by the end of the March. In the meantime, I would strongly advise active involvement by PCNs in any work locally on neighbourhoods, to ensure general practice actively influences how they are to develop.

Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs.