Since the publication of the NHS 10-year Plan we have been approached by a number of the PCNs that we support for advice on whether to change their organisational structure.
Our response is always to pose the same question ‘What is the actual problem that you are seeking to find a solution to?’. It is important to stress the word actual, to differentiate between known problems and perceived problems!
Since the creation of PCNs, a number have moved away from the ‘Unincorporated Association’ model set out in the DES to create Limited Companies or other incorporated legal structures. There are very valid reasons to do this, for example to create a legal structure to employ ARRS staff often with the aim of ensuring NHS terms and conditions and pension provision, or to create an NHS registered provider to provide services such as Enhanced Access.
Our preferred model has always been to maintain the Unincorporated Association and to use the practices that are the PCN as the ‘provider’ vehicle, therefore employing the ARRS staff in practices and organising for the practices to deliver the required services. There are a number of reasons why we prefer this model, the ‘top’ four being:
- We believe that the staff employed through ARRS, but employed in practices, feel better integrated in the practice team and this reduces turnover and increases job satisfaction.
- Our experience is that a practice employment and service delivery model improve the practice engagement in delivering the PCN DES and reduces or eliminates some of the issues raised elsewhere – such as, ‘we haven’t the space to accommodate PCN staff or services’.
- We can clearly demonstrate that a practice-based model significantly increases the ‘profit’ generated to sustain and develop practices and services. It is inevitable that a separate PCN organisation will cost more to run.
- We recognise that whilst incorporating a PCN may bring solutions, it will also inevitably bring new challenges particularly around the costs and technicalities of running the company, but also in respect of the complexities around shareholdings and tax for the constituent partnerships.
So does the 10 Year Plan change our thinking? The short answer is that it may, but we don’t know yet! It may be, for instance, that it will be easier for a PCN that has morphed into an Integrated Neighbourhood Team (INT) to hold a new INT contract if it has a formal legal structure or that the type and range of services that may be devolved to INTs from Acute Trusts may require ‘at scale’
provision (i.e. not suitable for devolving to practices).
Our advice is to keep your options open and as always to focus on the actual problem that you are seeking to find a solution to, and then once you’ve defined the problem, look for the solution that best solves the problem!
Our fear (as always) is that advisors (or indeed sometimes our colleagues) will advocate the solution before defining the problem it is trying to solve.
Mike Pyrah, Co-Founder
Howbeck Healthcare (July 2025)
