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PCNs are the building blocks on which the great structure of the health and care system sits. But what foundations are they built on? An ever-changing and, some would argue, unpopular contract set to end in just over a year, a dwindling exhausted workforce, a lack of funding, a lack of estate, stretched practices. And a backdrop of revolving health secretaries, winter pressures and new parents in the form of integrated care boards (ICBs). Perhaps Matt Hancock isn’t the only one who wants to disappear off to the jungle.
But PCNs haven’t taken flight or even left the building (which is most probably outdated). It’s actually a wonder how much some PCNs have managed to achieve.
To tackle unsustainable demand The Foundry practice in Lewes, East Sussex has divided patients into a traffic-light system of need. This split of urgent on-the-day care where continuity is not a priority was a key recommendation of the Fuller Stocktake. While some see it as a threat to continuity, others see it as a way to preserve continuity for those that need it.
And as Professor Aruna Garcea told Pulse PCN, while she became a GP to deliver cradle-to-grave care she recognises the landscape, complexity and demand have changed and so must delivery of care.
Another feat of PCNs was the delivery of the Covid vaccination programme and how they are building on that work as discussed in our latest roundtable. It highlights the positive outcomes of PCN outreach. The vaccination programme shone a light on the communities that were not well served by the health system. PCN leads got out and met people in their places of worship, in town centres and uncovered significant need. But they point out that much of this work is done in their own time and is not funded.
And on the subject of funding, what are PCNs to do when the contract ends in March 2024? An NHS Confederation report, published in November, called upon NHS England and the Department of Health and Social Care to remedy the ‘rollercoaster’ of the past three years and guarantee PCNs’ continuation.
NHS England, in its winter support measures, published in September, stated its commitment to the development of neighbourhood multi-disciplinary teams in primary care with the additional roles reimbursement scheme (ARRS) being central. It encouraged PCNs to use all ARRS funds and continue to recruit ‘with the knowledge that support for these staff will continue’. But NHS England stops short of doing the same for PCNs.
To ensure this huge building remains standing, NHS England must shore up the foundations by guaranteeing the continuation of PCNs and detailing a new long-term contract informed by the profession. It must recognise the excellent work of PCNs where the conditions have been right for innovation and collaboration and urge ICBs to help create this atmosphere across the country.
It must provide a significant budget for management of PCNs and the training of the new ARRS roles and of new primary care professionals.
Only then can it build a health and care system with solid foundations.