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Digital and transformation leads were added to the additional roles reimbursement scheme (ARRS) in September ‘to optimise new technology and other initiatives’ across PCNs. Dr Neil Paul explains the role
It probably shouldn’t have been a surprise when NHS England told us we could use additional roles money on a digital and transformation (D&T) lead – one per PCN, maximum band 8a. This seems a reasonable response to the complaint that we have struggled to get innovation implemented and this is a way of pushing the accelerate button.
NHS England has said these roles must use data to: improve patient access and staff experience; support population health management; understand the ‘type and intensity’ of training needed; facilitate clinically led innovation; make sure practices are using the latest technology to offer more phone lines; monitor their call response times; and offer support with the NHS app which, since November, helps patients review their test results.
Should you have a D&T lead?
While it sounds attractive, remember the original aim of the additional roles reimbursement scheme (ARRS) was to reduce the workload of the GP. Perhaps its unstated aim was to get more patients seen. We were encouraged to adopt new clinical roles in primary care that had been piloted but hadn’t taken off widely.
A good question for a PCN is: ‘Are you going to get more value from this D&T lead than from, say, an advanced clinical practitioner?’
To be worthwhile, the role must deliver value to practices and patients. It should not end up trying to promote top-down solutions that the PCN or practices don’t support, or filling in spreadsheets to
‘feed the beast’.
Consider splitting the role
The role is advertised as ‘digital and transformation’, and while these are linked, they could be separate tasks with overlap.
The digital side of the role covers everything from data analysis to strategic planning. The transformation side covers building relationships with the wider system and facilitating working between practices.
You don’t need to have one person that does it all. Decide what is important and hire accordingly. My PCN is thinking of having two people working half time – one delivering the digital and the other transformation, with significant overlap.
Think about sharing with other PCNs. Many PCNs work closely with others, perhaps in a federation.
Who to hire
The role is quite high level but the D&T lead shouldn’t spend their life in meetings. They should help practices deliver their GMS and PCN work and look at what help is needed by practice managers, PCN managers and partners. It is a lead role – it is not about admin nitty-gritty like updating smart cards and changing printer cartridges. Of course, you may have suitable internal candidates who have primary care IT expertise and experience is key – and may be hard to find in outside candidates.
I would be wary of taking on ex-clinical commissioning group (CCG) staff who are displaced and looking for work. Some may be excellent and have the right skills, but many won’t understand the operational pressures of primary care and may struggle to know who they are serving or may not have the right IT background.
Some PCNs are wondering if they can nominate their existing PCN manager to be their transformation lead and fund them from this pot. I understand the thinking, but would be cautious about this. Will you get more work done? This role is about adding capacity.
However, this approach might free up DES and leadership money to spend on something more flexible that doesn’t have to follow the ARRS rules, including more clinical director or GP time. I know some managers are attracted to this option as there has been a statement that ARRS funding will be guaranteed whereas leadership money may not be.
Using third-party suppliers may be an option. The scheme was originally meant to fund employed posts, but many PCNs have outsourced other roles to charities, federations or companies that have the right skills. However, there is a danger that they will assume the role is to take part in meetings instead of going to a practice and actively trying to improve the lives of staff. Also, there is a worry that outside contractors won’t understand primary care, but many are bright people with interesting skills and could bring valuable expertise. However, they may be used to higher wages than 8a level.
I’ve seen lots of negative comments on forums about the role of D&T lead. As I’ve stated, the key, if you are using this role, is to make sure they add value to practices. In my PCN I’m confident that we can develop the role so that it will.
The role can be useful to help practices and clinicians, so think carefully what you want the D&T lead to do and make sure you get the right person. Also, think about sharing the person with another PCN.
Dr Neil Paul is a GP partner in Cheshire and clinical director of Sandbach, Middlewich, Alsager, Scholar Green and Haslington (SMASH) PCN
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