ICB approves 8k-patient GP practice to become its own PCN

An 8,000-patient GP practice in rural Cumbria has been given the green light to become its own PCN due to ‘geographical isolation’.

Waterloo House Surgery in Millom – which is run by Cumbria Health and has a list size of 7,955 patients – asked Lancashire and South Cumbria ICB to leave the Barrow and Millom PCN it is currently part of and establish a new separate PCN.

The ICB will allow the change despite the new PCN not meeting the requirements described within the DES, as it will consists of only one practice with a list size below 30,000 patients.

It will be the smallest PCN in England, followed by the Marsh PCN in Kent, which cares for 17,000 patients.

Allowing Waterloo House to form a separate PCN will mean services can be delivered ‘to meet the needs of the Millom population’, according to an ICB paper evaluating the change.

The ICB acknowledged that it could be seen to be setting a precedent to allow for single-practice PCNs, but said that this risk is mitigated by ‘the unique geography’ of Millom and the impact this has on delivering the requirements of the PCN DES.

It said: ‘Millom is a small, isolated town approximately 45 minutes away from the centre of Barrow, where the other PCN’s practices are located.

‘Given the geographical isolation and the different population demographics it has been difficult for the Barrow and Millom PCN to design and mobilise services that meet the needs of the patient population across the PCN footprint.’

The ICB also noted that the new PCN would not meet the DES requirements but it said that the DES recognises there will be ‘exceptionality’ to these requirements, in particular where a community has a low population density across a large rural and remote area.

It also noted that the risks are ‘further mitigated by the contract being held by a large-scale provider’, Cumbria Health.

The patient participation group for Waterloo House and the town board chair for Millom have both written letters of support for the proposed changes ‘citing the benefits they see for the local population’.

Medical accountant Andy Pow told Pulse that the decision sets a precedent which may be viewed as an opportunity to create ‘smaller practice-focused PCNs’ particularly in rural areas where geographical limitations could be similar.

He said: ‘Whilst there are merits with the geographical issues, this will present challenges for the existing PCN through lost funding and also the need to review existing ARRS staff roles especially where staff provided services to the new PCN patients.

‘It also sets a precedent which may be viewed by others as an opportunity to create smaller practice focused PCN’s particularly in rural areas where geographical limitations could be similar.

‘This could allow practices to take greater control over their PCN budgets which many would wish to do.

‘It is interesting that the proposal gained support as the practice is run by an “at scale” provider which added weight to the argument that this could happen even if that provider runs no practices in the immediate vicinity.’

A spokesperson for Lancashire and South Cumbria ICB said: ‘Now that Millom is the only practice within the ICB that is located within the boundaries of the recently-formed Cumberland Council, this change allows for PCN services to be fully aligned with the local authority footprint, meeting the local strategic needs and improving the ease of access to services for patients.’

Earlier this month, the ICB made the decision to go ahead with a controversial plan to put a popular GP’s APMS contract out to a competitive re-tender.