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Working-at-scale or working differently in 2024

In an increasingly collaborative and integrated environment, 2024 sees primary care continuing to explore the benefits of at scale delivery and transforming the patient care experience. Much has been written on the subject, by a number of organisations not least the chair of PCC in 2022, General practice at scale – PCC (pcc-cic.org.uk). This article does not seek to review such a comprehensive commentary rather reflect on where we are in 2024.

This year, primary care networks (PCNs) are having their fifth birthday and continue to evolve after the challenges of the pandemic. Whether occasioned by changes to the national specification or the delivery models adopted by PCNs, there is no doubt of the direction of transformational travel. Of course, the true value of PCNs is not simply their collective working-at-scale but their position in a system that operates and evolves for their local neighbourhood, maximising the potential of different layers of scale across primary care.

While not contractually recognised formally, it would be remiss not to reflect on the local GP federation models that often facilitate a wider primary care footprint for service delivery. Typically, they form organisations with a view to hold contracts as a provider or deliver as a sub-contractor for PCNs or GP practices and this simply enriches the primary care environment.

Leadership is pivotal, whether in a GP practice, PCN or federation, to create an environment that successfully adapts to the evolving challenges in primary care. Not limited to the senior partner in a GP practice or the clinical director of a PCN, true leadership filters down through the organisational layers. The effective leadership of the ever-evolving ARRS roles in a PCN even where the changes to the GP contract in 2024/25 seek to simplify with an overarching PCN specification, remains a challenge and one which PCNs should be mindful and supportive of.

With the coming into force of the Provider Selection Regime (PSR), a less shackled procurement environment for primary care appears to be available to commissioners, which is yet untested. The options when commissioning a new provider contract offer a consideration framework arguably favouring a reasoned contract award to known local providers. However, the PSR framework options of three direct awards, most suitable provider or competitive process, mean any decisions to use one of those award routes must be reasoned and the statutory guidance provides a basis for such consideration. In the absence of a new contract, as is often the case with GP contracts, the questions of list dispersal, merger or novation often arise and to some degree the statutory guidance supports such considerations, but it does not provide all the definitive answers for every scenario some may have preferred such as how do you calculate a material change for a GMS in perpetuity contract – as with any decision, whatever the outcome, reasons are required.

With integrated care boards (ICBs) fully delegated, and the requirement for an integrated care partnership, the contribution an at scale primary care environment may provide to national policy direction and whole system improvements should not be underestimated; think integrated neighbourhood teams and the matters raised in the Fuller stocktake. While general practice remains the bedrock upon which innovation is driven, the diversity of local organisational form can be seen both within general practice and in the wider primary care footprint. The interest by GP practice contractors to become a corporate entity is slowly increasing whether that be as a company practice or a PCN formed company holding primary medical contracts with a view to a merger of practices somewhere in the future. But whether such is working-at-scale or simply working differently will depend on the local circumstance. If these practice moves provide a platform for contributing to building a more resilient primary care with a wider involvement of NHS Trusts blending with secondary care only time will tell if true benefits accrue.

Paul Burns, PCC adviser and Mike Fry, PCC adviser

PCC can advise and provide hands on support to practices and commissioners considering mergers, incorporations and other forms of at scale working contact enquiries@pcc-cic.org.uk of visit www.pcc-cic.org.uk to find out more.

Last Updated on 25 March 2024