What are Primary Care Networks (PCNs)?

Primary Care Networks (PCNs) are groups of general practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services in their local areas. Introduced in England as part of the NHS Long Term Plan in 2019, PCNs represent one of the most significant reforms to general practice in recent years.

PCNs typically cover populations of 30,000-50,000 patients, bringing together neighboring practices to collaborate on delivering enhanced primary care services. Rather than replacing individual GP practices, PCNs create a structure where practices can work collectively while maintaining their independence and unique identity.

Key Features of PCNs

• Collaborative Structure: PCNs involve GP practices formally agreeing to work together, sharing resources and expertise to provide more coordinated care
• Additional Funding: PCNs receive specific funding to employ additional staff and deliver extended services
• Designated Clinical Director: Each PCN has a clinical director, typically a GP, who provides leadership and maintains clinical governance
• Network Contract DES: Practices in PCNs are signed up to the Network Contract Directed Enhanced Service (DES), which outlines their obligations and funding arrangements

The Additional Roles Reimbursement Scheme (ARRS)

A cornerstone of the PCN model is the Additional Roles Reimbursement Scheme, which provides funding for PCNs to recruit a range of healthcare professionals, including:

• Clinical pharmacists
• Social prescribing link workers
• Physiotherapists
• Physician associates
• Paramedics
• Mental health practitioners
• Care coordinators
• Health and wellbeing coaches
• Dietitians
• Podiatrists

These additional roles aim to expand the primary care workforce, reduce workload pressures on GPs, and provide more comprehensive patient care.

PCN Service Requirements

PCNs have specific service requirements, which have been introduced gradually since their formation. These include:

• Structured medication reviews
• Enhanced health in care homes
• Anticipatory care for high-risk patients
• Personalised care
• Early cancer diagnosis support
• Cardiovascular disease prevention and diagnosis
• Tackling neighbourhood health inequalities

Benefits:

• Improved access to primary care services
• More coordinated and integrated care for patients
• Greater resilience across primary care
• Better work-life balance for healthcare professionals
• Enhanced prevention and population health management

Challenges:

• Variable implementation across different regions
• Administrative burdens and governance complexities
• Balancing PCN work with core practice duties
• Managing relationships between practices with different sizes and priorities
• Workforce recruitment and retention difficulties

Conclusion

PCNs represent a significant evolution in primary care delivery in England, aiming to strengthen general practice through greater collaboration and workforce expansion. While challenges remain, the PCN model offers potential solutions to many of the pressures facing primary care, from workforce shortages to increasing patient complexity.