Recruitment. A word that fills most clinical directors with either hope or anxiety. Can we find good candidates to fill our posts, and will they choose us over other organisations? If they do not, how will we explain this to our practices? If they do, will the amount of supervision required lead to practices not wanting us to place them? Creating a skilled workforce that will be the foundation (and legacy) of the Network DES is significantly more complex than I think was originally envisaged, and even without the challenge of a pandemic, requires PCNs to invest in time and infrastructure to be successful.
In London, although there may be larger pool of potential recruits, the ratio per capita makes this as difficult as the rest of the country. The cost-of-living drives salaries up and is recognised by acute and community healthcare trusts and even some GP federations through the High-Cost Area Supplement (HCAS), otherwise known as London Weighting.
It has long been a plea from networks in London that they be given the same allowance within their ARRS reimbursement caps, ideally together with a commensurate increase in the total budget. Theoretically, this would make jobs in primary care more enticing compared with other sectors and aid the recruitment and retention of staff.
Many PCNs had already been forced to utilise their core network payments to supplement salaries to attract new staff, let alone to plan for wage increases with competency and experience. Now that HCAS has been approved – albeit without a change in the total funding – some of these problems appear to have been addressed. Or have they?
Like many things there may be unintended consequences. Networks now have more breathing room in the short-term and can plan a progression salary scale without significantly disrupting their viability. However, it also means that we will recruit less staff overall and there is still the potential to drive up salaries in the future as the well-funded acutes respond to market forces. In addition, the 5% difference between inner and outer London Weighting could disadvantage PCNs at the border and paradoxically increase their recruitment challenge.
Although my view is that the benefits outweigh the risks, we will only see with time whether this was the right decision for the system. Either way, it is still crucial for PCNs to ensure that the entire package they offer in terms of training, supervision and mentorship remains strong and is largely a reason why many PCNs, despite a pandemic and the reimbursement constraints, have been successful in using their entire ARRS budget.
Dr Sarit Ghosh is clinical director of Enfield Unity PCN, North London; lead partner at Medicus Health Partners; co-chair of Enfield GP Federation; and Pulse PCN editorial advisory board member