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An equal shot



Primary care at scale can improve patient care if it is properly resourced, argues Victoria Vaughan 

Variation in healthcare is not new. The NHS is the world’s biggest employer of highly skilled professionals. It is complicated, it is fallible. While there is, and always should be, an aspiration for care to be the same excellent standard across the system, attaining this is another matter. There are under-doctored areas and underserved communities. There are increasing demands, waiting lists and disease burdens. There is not enough funding. There is Covid.

Tackling health inequalities has always been part of the PCN remit. It is one of the service specifications set to come this autumn, although it remains under negotiation. And a report from the NHS Confederation’s PCN Network, Primary care networks two years on, found that 87% of PCN leaders believe no service specifications should be introduced in 2021/22.  

But a delay doesn’t mean work will not get under way. PCNs are small and agile enough to know the issues, yet big enough to tackle them. As our autumn issue cover feature illustrates, many CDs and GPs are already making a difference, providing services to reduce health inequalities.

But they need support. The problem set out in The Marmot Review a decade ago is still there and has been exposed by Covid. Studies carried out in the pandemic found an increase in domestic abuse, a worsening of mental illness, loss of income through self-isolation, an increased burden on mothers and an impact on the mental health of NHS staff. The challenges are now greater. 

In a recent US think-tank report Mirror, Mirror 2021: Reflecting Poorly, the NHS lost its ranking as the top- performing health service, falling to fourth out of 11 affluent countries. In the area of income-related disparities, the NHS also slipped from top spot to fourth. These findings cannot be ignored. The problems health leaders have been highlighting for years are having an impact. This is, of course, all set against the new Health Bill. Primary care at scale can improve patient care if ICSs grant proper resources.

There is also a valid concern that PCNs could exacerbate inequalities as discussed in our roundtable on the additional roles reimbursement scheme (ARRS). While the ARRS has improved patient care, particularly in the area of medicine optimisation, it has been less good for communities where recruitment is difficult. Those areas were already underserved. Is the solution for PCNs to help their neighbours to fix this issue – a network of networks as mentioned in the PCN Network report? 

Where the workforce is in place there are challenges with space, training and management. The ARRS does not solve the GP shortfall. PCNs need the flexibility to employ who they want as they want, perhaps with part-time or temporary contracts. Larger PCNs, or PCNs in a federation seem to cope better, as outlined in our PCN profile of Tower Hamlets in east London. But again, inequalities have to be tackled by working closely with communities. The more remote provision gets, the less things will change. PCNs need the flexibility, support and resource to to achieve their potential and make a real impact. 

Victoria Vaughan is editor of Pulse PCN

READERS' COMMENTS [4]

Patrufini Duffy 16 September, 2021 2:13 pm

Opting out of a PCN has made zero impact, but instead yes no dangling money, but greater clarity and resourcefulness and less friction. And no need for that burdensome “I owe you”. Funny real world observation that.

Turn out The Lights 16 September, 2021 4:14 pm

Inequalities in healthcare good research going on for over 50 years,we’ve known the problems, and if anything thigs are just as bad if not worse than 50 years ago.Epic fail would come to mind.The solution is more likely to be found in fiscal and politics rather than on the in tray of medical Drs.

David OHagan 16 September, 2021 4:59 pm

PCNs may be miracle workers, but dealing with the inequalities made worse since 2007 might be a bit beyond them.

It is true that even the least of our PCNs has more talent than the cabinet, but sadly that is not a great boast.

National level understanding of the causes of ill health is required. We need a government which understands that generating headlines and clickbait and whistles does not improve health. All of these measures increase mental health problems, increase despair, and increase physical health problems.

If at the same time you reduce the proportion of (a falling) GDP on health, healthcare and social care. There is no PCN in the country which is going to be ideally placed to reverse the effects.

Having cake and eating it is all very well even if it is oven ready, but until our government reflects the needs of the country we might as well pass round a few bandaids.

David Jarvis 30 September, 2021 11:18 am

PCNs are probably still small enough to be divisive in equality. Well resourced practices in affluent areas will do well. Under-resourced practices in poor areas likely to do badly. The governments fear of some GP’s being profitable really stifles clear unfettered investment in the areas of most need and the best profits are to be had in the “nicer” areas where patients are compliant with improving their health. Oddly the much maligned QOF may have had some benefits in attaching resources to health improvements but will still reward practices in leafy areas more.