• GPs set to form nearly 1,300 primary care networks next week
  • “Significant number” larger than the 50,000 recommended population ceiling
  • Very few practices have opted out

GP practices have formed 1,259 primary care networks across England, ranging from populations of less than 20,000 to more than 50,000.

NHS England believes more than 99 per cent of GP practices will be signed up to the network contract when PCNs go live next week.

The mean average population covered is around 42,000. The original guidance network contract earlier this year said PCNs should cover between 30,000 and 50,000 people. However, NHSE confirmed there will be many outside these bounds.

There will be 83 networks covering fewer than 30,000 patients, of which 26 are under 27,000, and two – in sparsely populated areas of Cumbria and Yorkshire – are under 20,000.

However, there will be a “significant number”, as yet unspecified, with populations over 50,000, NHSE has said. In some areas GP practices – which agreed their footprints working with clinical commissioning groups and NHSE – have formed networks spanning quite large areas and numbers of people.

NHSE national director for strategy and innovation Ian Dodge said: “Originally in the deal, we said we didn’t want to create additional bureaucracy by forcing people if they were actually one large grouping of six neighbourhoods each of 50,000 to have to register as a separate PCNs.

“We don’t mind if they’re a big single PCN, [as long as] in practice what they’re doing is they’re showing within that they’ve got their own almost internal neighbourhood areas which are the areas that community services can then configure their teams around and dock with.”

Joining a PCN is voluntary but comes with additional funding. As of yesterday there were 30 practices which wanted to join a network but had not agreed membership with one; NHSE expects to reduce that to one by next week.

Some of the reasons for their present exclusion were described as “wicked cases” in an NHSE board paper. These included an acrimonious partnership split in the past, an instance where one practice is still involved in a legal dispute with its only obvious network partner, and another where the practice is currently under investigation.

Mr Dodge said there were 25 practices – out of about 7,000 practices nationally – which had “actively decided not to take part”.

Their reasons included an unwillingness to end half-day closing, unwillingness to work in partnership with other practices, not wanting to grow their business and take on associated responsibility, and concerns about the level of future workload.

NHSE interim clinical director for primary care Nikki Kanani said: “The things that have tripped local areas up are relationships more than anything.”

Practices, with CCGs, local medical committees and NHSE, have been working to agree network patterns since late January when the contract was published.

Mr Dodge praised the effort of LMCs and CCGs and said: “I’d say that this has gone better probably than either we or the BMA expected thus far.”

Each PCN has to have a nominated payee to receive funds to pay for additional workforce and services which are due to be provided across a network under the contract.

NHSE indicated that, for the vast majority of PCNs, this would be a member practice or an existing GP federation, largely because it wanted them to already be registered on its payment system. However, NHSE said it hoped to “be in a position in the future where we can further liberalise who can hold the money”. It had previously said NHS trusts would be able to take on this role.

Networks are intended to bring together practices in geographic groups, covering the population of England. It is intended they will work closely with community health services in their areas, which will be asked to configure their teams around the PCNs, as well as partnering with others, and improving their population’s health.

NHSE is due to publish more detail on networks this afternoon – follow HSJ news for details.

Update: this story was updated at 17.15 to include various reasons why some practices have yet to be incorporated into a network, and why others have opted out of the network contract.