Mind games

GPs are being asked to carry out an impossible workload as PCNs, yet told they’re lazy for not seeing patients face to face, says Victoria Vaughan

A sense of fatigue is setting in for GPs at the helms of PCNs. 

There is no doubt that the formal structure of a PCN has been a game changer when organising the initial response to Covid, planning vaccinations or, more recently, looking after refugees from Afghanistan. But the original remit, of freeing up clinician time by getting more people into general practice via the additional roles reimbursement scheme, is actually adding to workload– because of the need to train and manage these new employees. 

Add to that the rhetoric around face-to-face appointments and the requirements attached to the Impact and Investment Fund, and you can start to see why there is fatigue. 

I’m wondering if the Department of Health and Social Care has forgotten that PCNs are actually made up of and run by GPs? Clinical directors (CDs) are not a new breed of manager, they are GPs – invested in GP practices. 

It seems like some sort of weird mind game is afoot. On the one hand, they are asked to carry out an impossible amount of work as fabulous PCNs. At the same time, they are ordered to be less lazy and see more patients face to face to increase access. 

And of course, this would actually decrease access, as more patients can be seen in a day with online and telephone consultations. Data from the BMA show that the total number of appointments delivered by general practice in August, 25.5 million, is higher than pre-pandemic levels – 23.3 million in August 2019. And currently more than half (57.7%) of consultations are being delivered face to face. The CDs I’ve spoken to report that patients opt for remote consultations even when offered them face to face. It’s more convenient than missing work or sitting in a waiting room full of sick people. 

Here’s another thing that’s perplexing. NHS England and NHS Improvement proudly circulate the Covid booster vaccine figures; a press release on 7 November reported: ‘More than 371,000 people were recorded as receiving a top-up on November 6, meaning almost 8.5 million have received one in the seven weeks since the latest phase launched.’ This is the booster programme the health service was asked to do at a moment’s notice. This – and the flu vaccine programme – are not delivered by online appointments. Many are taking place in practices. So are they breaking records or under-performing? 

So what exactly is the end game? If GPs go off the idea of PCNs, how will the leading few achieve anything? How will they get their voices heard at the ICS? How will they keep morale up? This is discussed in our latest roundtable, where one participant wonders how to future-proof the PCN leadership in the face of these challenges.

Perhaps the health secretary Sajid Javid could consider working with the cornerstone of the health service, as allies in managing patient flow, rather than taking a punitive stance. And maybe he’ll acknowledge that for networks to achieve anything they need a GP workforce that is not demoralised. 

Victoria Vaughan is editor of Pulse PCN