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The route to being an effective primary care network (PCN) has changed. That’s because PCNs have changed. At their inception, they were about getting the practices in the PCN together, agreeing on how they would work, and taking on a link worker and a pharmacist. At that time, the PCN was about making the most of the additional roles and resources and agreeing how to work these across the practices.
Now things are different. Now it is all about being able to deliver. For many PCNs, the first need to deliver came with the vaccination programme. Since then, PCNs have assumed responsibility for enhanced access and have had to deliver against the Investment and Impact Fund (IIF). And they are seemingly about to take on the delivery for in-hours urgent care.
But is it possible for PCNs to be able to deliver effectively? Is the role of the Clinical Director (CD) – the responsible officer for all of this delivery – doable? Or have PCNs simply been set up to fail?
Some PCNs have very successfully taken on this delivery challenge. From the work that I have done with them, I have identified four common steps that all of these PCNs have taken.
Step 1: Put a PCN Clinical Leadership Team in Place
The average PCN will turn over well over a million pounds next year, often double that. They have grown in size and scale and can no longer be run by the CD in a couple of sessions a week.
Effective PCNs have put in place a leadership team of clinicians from across the PCN. For example, there is a lead GP or clinician for enhanced access, one for IIF, one for the pharmacist team, and one for the social prescribers and health coaches.
It means the role of the PCN CD has changed from the person doing the work – i.e. interviewing the pharmacists, inducting the link workers and so on – to the person ensuring that everything is being done. They make sure that each area of work has its own lead, that they have the support they need to carry out these roles, and that the resources across the PCN are being utilised effectively.
Step 2: Establish a PCN Framework for Making Change
These PCNs are learning from each time they have had to deliver and have established a clear framework for how they make changes in their PCN.
What is right for one PCN is often not right for another, but there are common elements of these frameworks. For example, they tend to include a process for agreeing whether or not to go ahead with a new initiative and how this will be done with some upfront discussion across the practices. The CD does not simply impose the decision. There is also clarity on roles and responsibilities for all in the delivery process – leaders, practices and additional roles. And there are implementation plans that include an agreement about how resources will be deployed. Finally, they have communication processes, including ongoing feedback and reports across all the practices.
These frameworks can vary quite considerably. For example, some PCNs prefer to create PCN teams to lead new initiatives, whereas others go for minimal central coordination and more individual practice responsibility. Regardless of the approach, the important thing is that each PCN learns from its own experiences as to what works best for implementing change and builds on that each time a new initiative comes in.
Step 3: Make the Practice Manager Group Part of the PCN
Practice managers are of vital importance when it comes to delivery in most practices. The practice managers in most PCNs will often meet as a group. But what rarely happens is this practice manager group being recognised as a key part of the effective functioning of the PCN.
Yet delivery across a PCN nearly always means delivery within each member practice. And so many of the most successful PCNs have recognised those PCN practice manager groups as a key part of the PCN. The PCN ensures they have the information, time and resources needed to support implementation within each of their practices.
Step 4: Build a PCN Management Team
The practice managers are an important group, but they also have a day job that takes up most of their time. So, they do not have the spare capacity required to implement larger-scale projects such as enhanced access or urgent care across the PCN. For this, additional management capacity is required.
This can be addressed now that the Digital and Transformation Lead has been included within the list of Additional Roles Reimbursement Scheme (ARRS) roles. Since the Digital and Transformation Lead’s purpose is defined as supporting transformation across the PCN, there is readily available funding for relatively senior and skilled management resources to support the PCN. This is not to replace the administrative and lower-level management support that these PCNs already had in place. Instead, this is to supplement it and enable the PCN to successfully take on larger-scale and more complex projects.
The PCNs successful at delivery have built PCN management teams on top of creating a clinical leadership team and investing in the practice management team. It is this infrastructure, along with a clear process for making changes, that will enable effective PCNs to meet the existing delivery requirements – and set them up for future success.
Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs.