Revealed: 40 per cent of PCNs flout NHSE guidance on size

HSJ can also reveal that other primary care professionals are almost entirely absent from a PCN leadership dominated by doctors – despite one of the most important tasks of the networks being to extend primary services beyond traditional GP care. 

There are 1,259 primary care networks in England, and HSJ has received data from 1,222 of them, and from 187 of the 191 clinical commissioning groups. This allows the most comprehensive analysis of the PCN landscape so far.

The PCN concept suggests network will achieve optimum results if they are serving populations of between 30,000 and 50,000 people, built from the lists of their constituent GP practices.

Data collected by HSJ shows most PCNs fall within this boundary, and the mean average list size is about 48,000. However, 41 per cent of networks are outside the range.

There are 99 (8 per cent) below the 30,000 threshold, which was characterised by NHS England as a “hard bottom” below which networks would struggle to achieve the advantages of operating at scale. There are three PCNs smaller than 20,000, which are typically very rural, meaning a large geographical area is covered.

HSJ’s analysis shows there are 410 PCNS (33 per cent) above the 50,000 ceiling. NHS England has indicated this is more acceptable, but the 36 PCNs serving over 90,000 may stretch the logic that the networks are able to be responsive to local needs.

Some of the largest PCNs have stressed they are operating through smaller constituent networks, although they typically have a shared clinical director leader.

Ten largest PCNs by population covered

* Note: Barnsley PCN is described as a super-network by its CCG. It has been subdivided into six sub-network neighbourhoods ranging in size from 33,408 to 56,808.

Ten smallest PCNs by population covered

The smallest network, Western Dales PCN was allowed to adopt such a small list size because its “rurality and geographical layout meant that the opportunity to ensure ‘natural community’ of 30,000 patients would be challenging” according to Morecambe Bay Clinical Commissioning Group. The CCG will reassess the network’s size before the start of 2020-21.

More than 96 per cent of PCNs have one or more doctor in their clinical director role – the lead officer for each network.

The clinical directors do not have to be doctors, and PCNs are intended to develop multidisciplinary working, growing non-medical staffing in primary care.

Most of the networks have opted for a single clinical director to lead their work, but 15 per cent have decided to share the job between two or more people. The most across a single network is four.

NHS England has touted its success in bringing forward a new generation of clinical leaders, saying many PCNs had appointed individuals who had not been in a leadership role before. NHS England and Improvement chief nurse Ruth May said in September the organisations wanted more PCNs to have nurses as clinical directors, and announced funding for PCN nursing leadership.

Subscribers to HSJ Intelligence will soon be able to read the full details of HSJ’s analysis of the emerging PCN sector, including details of every PCN, a regional breakdown and the crucial role of super-partnerships