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Back to the future



We should look ahead and give PCNs the space to innovate for their local populations, says Victoria Vaughan

Winter draws to a close. Footfall in booster clinics is dwindling. You could be tempted to look back and take stock. But there’s the reorganisation of the NHS. The shift in architecture, which sees the end of CCGs and lift-off for integrated care systems (ICSs). Also, PCN specifications ramp up in April to include personalised care and anticipatory care.

As outlined in our feature on how networks are preparing, these things may be on the horizon but who has had the chance to look the future? Not PCN clinical directors (CDs); not think-tanks; and judging by my still-pending queries on the next phase of PCN work, not NHS England. But I have the sense that CDs are okay with this. They’ve become used to hearing things first via Pulse and the national news. 

Much of the new work has already begun. The frail and elderly, who will benefit from anticipatory care, have been identified in the care home specification, Covid measures or other PCN work. Population health projects are under way (as discussed in our roundtable). For the personalised care element, social prescribing link workers have been hired through the additional roles reimbursement scheme (ARRS). But this way of providing care tailored to the patient and anticipating their future health concerns requires support. 

PCN CDs can see the future for this type of care. They want to prevent children becoming their parents with diabetes, hypertension and cardiovascular disease. But can this new system fund that kind of long-term healthcare? Can those at the ICS reach down and engage with their PCNs? Can they fund a more responsive, locally thought-through kind of care? 

Added to these challenges are the findings of the NHS Race and Health Observatory, reported in The Guardian, but not yet published at the time of going to press. According to The Guardian, the review, led by Manchester university, highlights that woeful collection of ethnicity data has ‘negatively impacted’ the health of black, Asian and minority ethnic people in England for years. This mirrors the experiences discussed in our roundtable, where one CD says that although data about ethnicity and vulnerability to Covid were good, they weren’t available at a practice level and had to be recaptured. 

There has long been a problem with the sharing of data in health. As we move to a preventive, responsive health system, data have huge potential to help plan and co-ordinate healthcare. So while the past must be examined, PCNs must look to the future. Now, as ICSs get going, is the time to pull together for the care that will work for your populations. As our columnist Dr Manu Agrawal cautions LMCs and PCNs must not be pitched against each other.

So looking ahead, ICSs should have a ring-fenced fund to back the preventive work that will minimise costly healthcare in later life. They should also commit to funding PCN-driven work. While there will be easy wins with widespread health issues, local needs may differ around the country and money could be better targeted by PCNs given the space to innovate. 

Lastly, work needs to be done on better sharing and collecting of data. Covid has shown that data can be shared. This needs to be looked at again. 

Victoria Vaughan is editor of Pulse PCN.