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PCN workload leading to ‘burnout’ and ‘high turnover’, says NHS body

Primary care networks in England are shouldering heavy workloads that are leading to ‘burnout’ and a ‘high level of turnover’ among their clinical directors, the NHS body representing health service providers has found.

In a new NHS Confederation report published today, the body's PCN network said clinical directors must be given further support to mitigate workload issues, including leadership training and funding for non-clinical managers under the PCN additional roles scheme.

The report, which looked at PCNs one year on from their launch in July 2019, said the ‘overwhelming pressure that has been placed on the shoulders of staff’ has meant that ‘in some areas PCNs have yet to make significant impact’. 

It added:‘The workload for PCNs has been heavier and more stressful than many anticipated, with much of this work falling to the clinical director. 

‘Huge pressure has been put on those working in PCN teams, exacerbated by Covid-19, and many clinical directors are concerned that it is not sustainable.’

The NHS Confederation added that ‘concerns have understandably been raised around burnout among clinical directors’.

‘If we are to address the high level of turnover among clinical directors, then they must be given further support’, it said.

Dr Mark Spencer, NHS Confederation PCN network co-chair and clinical director of Fleetwood PCN, told Pulse that leading a network has been ‘overwhelming’.

He said: 'As a clinical director, we've been pulled in so many different directions. Some of our clinical directors are fairly new to leadership [but] it's been overwhelming at times, even for seasoned leaders.'

Ruth Rankine, director of the NHS Confederation’s PCN network, stressed that around half of clinical directors are in their first clinical leadership role.

The network has been pushing for both investment in dedicated managers for PCNs as well as leadership training for clinical directors, she said. 

Ms Rankine told Pulse: ‘The manager role will help to free up the clinical director time so that it is spent where it needs to be spent and not doing some of the more managerial functions.

‘Equally it is also about investing in the clinical directors and their leadership capability that really supports those people in those roles. We need to invest in their development to really become strong primary care leaders.’

An NHS England spokesperson said it will 'continue to support and develop PCNs and clinical directors as they strive to improve access to high-quality primary care'.

They added: 'PCNs were at the forefront of transforming services in response to Covid and as this report states, staff are still optimistic and will be able to build on the ‘notable success stories of networks delivering tangible benefits for the health of their populations’ including ‘allowing more patients to be seen during the Covid-19 pandemic’.  

Last month, NHS England announced that 98% of GP practices have signed up to the primary care network DES this year - although a Pulse analysis of data supplied by CCGs showed that a slightly larger number of practices have opted out this year compared to last.

It followed the collapse of one PCN - serving 80,000 patients - due to concerns about the care homes requirements of the network DES, while others warned they were 'in danger of folding' over similar concerns.

And a report from Pulse's publisher Cogora revealed in April that more than a quarter of GP partners in England spent an average of 10 hours or more a week establishing their networks in 2019.

Earlier this year, one LMC told their practices that they could not advise signing up for the DES due to workload requirements.

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Readers' comments (20)

  • Vinci Ho

    Speaking as a CD:
    (1) It is hard enough to get your colleagues in your practice to have an agreement on certain matters , how hard is it to expand that to multiple practices of different sizes and backgrounds , with only limited resources ?
    (2) Most CDs are still engaging in clinical care which is already time consuming and becoming more complex . Dealing with the ‘one size fits all’ bureaucracy and technocracy every day in PCN is often like going around circles and finding no answer . The current ‘command and control’ is totally unhelpful for CDs as CCGs inevitably have to surrender and succumb to the reign of NHS England ( and equivalents) . But I insist , GPs , by default , are not subordinates of the government.
    (3) While I could see the merits of some additional roles like clinical pharmacist and social prescriber serving important roles during the last 13 weeks of pandemic drama , the ongoing concern in the financial status in PCNs remains ,albeit 100% reimbursement of these extended workforce . The practicality , legality and complexity of continuing to employ more additional roles (physician associates, pharmacy technician , health and well-being coaches , first contact physiotherapist, care-coordinator, dietitian, podiatrist and occupational therapist ) , is questionable especially PCN is yet to be a legal entity.
    (4) Small and large practices in a PCN have completely different or even polarised views on certain matters . That is a fact as well as common sense . CD is often faced with the choice of either going for a civil war or ‘no solution’ scenario. They are treading the fine line between leadership and dictatorship, quite frankly .
    (5)I stick to the argument that the original motive and intention of the government in setting up PCNs , is to get rid of funding GP practices individually as it was deemed to be too expensive . Once again, one size fits all is the strategy serving for the grand plan to destroy GP partnership once and for all .
    It took me pain to finally sign the PCN DES a few weeks ago . The way I put it to my comrade practice colleagues was , ‘ the gun is on your head , I just tried to push the gun barrel slightly sideways so that the bullet will not hit the brain ‘
    And please do not challenge me why I had not resigned by now......and I know I deserve little pity from at least , some of you .

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  • Sounds like you've done a lot Vinci but your hands are tied. I wonder what some other CDs have done to help except to attend useless meetings.

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  • I am told my PCN has £380K to spend on staff. The problem is that the staff we are allowed to spend the money on are not the staff we want or need. If we were allowed to use the money to pay staff more, appoint more admin staff, appoint nurses, even appoint doctors, then it might make a difference. I don't want chiropodists etc - completely useless.
    The staff we have employed have not been able to work independently, require huge amounts of training and support, and deliver next to nothing.
    We are getting rid of our pharamacist as she is not productive, and we are not allowed to pay to employ a pharmacist who can operate independently because of PCN rules.
    Our social prescriber sees patients at a rate of around one per day, yet is paid more than a full time fully trained practice nurse.
    PCNs have also taken up a huge amount of unpaid doctor and managerial time.
    Furthermore, PCNs haven't really delivered any new funding streams into general practice, and in many areas are being seen as an alternative place to invest money that would have come directly to practices.
    LMCs voted against supporting PCNs at the March
    Conference, and GPC should have now withdrawn their support for the project... but inexplicably they haven't.
    My advice would be - hold your nose and take the money this year, but plan to not sign up next year, before they grow into something we can't control.

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  • Social prescriber. What an absolute oxymoron of shambolic buffoonery. Why have we, a once proud profession, allowed ourselves to become so thoroughly trampled by idiots.

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  • Quelle surprise! It always seemed that PCNs would turn out to be another forum for more head banging or can kicking down and endless road.

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  • Whoami,
    And the answer is .........?

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  • @Andrew Challis- on a personal level, I’ve cut my sessions and portfolioed my career.
    On a whole profession level- that’s what a union is supposed to be for. But a union is only as good as its members.
    Maybe I’m too angry today. But other countries have happy, content GPs. In this country it seems all they want is for us to be risk carrying heart sink/elderly/psychiatric overflow mugs

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  • PCNs are of course another useless diversion away from proper General Practice.

    However, for CDs there is a very simple solution: if you don't like the job, resign. But most CDs won't, because for medium to large PCNs the role is rather well funded and a nice little earner for those involved (without having to trouble yourself with actual patient care).

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  • This new PCN layer is pointless and distracting. Cross-organisational working just doesn't work.

    Either give the staff to individual practices or use policy to merge practices - at the risk off killing GP.

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  • I am sympathetic to Vinci's plight. I am not a CD but a partner in a practice with CD. We are short of GPs and my partner is constantly occupied with PCN issues. I continue to struggle with the idea further efficiency savings and economies of scale are going to allow us to retain our humanity, work ethically and still generate profits for the business. How do any of us extricate ourselves, generate sufficient income and not go bust? Any ideas? I am tired and burnt out thinking up ridiculous operating procedures for more process driven targets.

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