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Dr Farzana Hussain on the purpose of PCNs
PCNs are now just over three years old. Most three-year-olds walk, fall over and get up again. We do not normally expect them to run marathons. In the NHS Long Term Plan of 2019, the ambition for our new baby was as follows: ‘for the first time since the NHS was set up in 1948, there will be a creation of fully integrated community-based healthcare’. Yet in the PCNs’ short lives, we have expected practices to come together to become one delivery unit, work in partnership with multiple organisations – often competing for resources – and embed and supervise more than a dozen new roles. There has been little support and often more top-down demands.
Despite this vast expectation, PCNs have delivered the most successful vaccination programme in the history of the NHS and many have worked innovatively to tackle difficult wider health issues such as the incidence of knife crime in young people. This project was undertaken in my own PCN, and it came on top of the day job of hitting impact and investment and DES targets.
So has the delivery of the vaccine programme led to big hugs, praise and treats for our toddler PCNs from the doting NHS parents? Unfortunately not. PCNs have been sent to bed early with the threat of no supper. Since the pandemic, the negative narrative about lack of GP appointments and reduction of face-to-face appointments has painted GPs and their teams as deliberately obstructive and lazy. There has been little support for practices, which are, of course, the foundations of PCNs.
And now we are morphing into another entity – integrated neighbourhood teams. It is unclear to me how another restructuring will solve any of the issues.
The unanswered question for me is this: what is the purpose of PCNs?
Are they here to sustain practices? This is clearly not happening as patients registered with small lists or in areas of deprivation are not benefiting from the additional roles reimbursement scheme (ARRS) staff who often work in a large practice, and in affluent areas. This is widening health inequalities.
Are PCNs here to tackle population health and work with communities on wider determinants of health and prevention? This does not seem to be the message from our Integrated Care Systems (ICSs), which are struggling to keep people out of hospitals. The focus is not on primary and community care. This is a different reality from the objectives of the Long Term Plan.
If PCNs are to succeed, we need to define what we are asking of primary care – which must include general practices as the foundation. We have to focus on priorities that will make largest impact. If we try to do everything, we will achieve nothing. We must have an equal voice in the large ICS boards and brave dialogue with our acute trusts. We will need a united primary care voice – which can be hard to achieve with the infrastructure of primary care being disparate, independent organisations. All this requires listening, humility and relationship building, which takes time.
Finally, we must remember that PCNs are not like human three-year-olds who often need direct instruction. Let’s have adult-to-adult conversations with all members of PCNs, not just the clinical directors, and let us have a break from restructuring and work on a shared purpose to serve our communities.
Dr Farzana Hussain is a GP and former clinical director of Newham Central 1 PCN in east London