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London calling



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 โ€“ albeit without a change in the total funding โ€“ 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

READERS' COMMENTS [5]

Vinci Ho 13 July, 2021 8:19 am

Fact :
I am a clinical director of a small PCN ( just over 30,000 in population).๐Ÿ˜ณ
Fact
I am a PCN-sceptic from day one to present day ๐Ÿ‘ฟ
Fact
The addition of clinical pharmacists and social prescriber had helped the practices a lot through the pandemic especially .๐Ÿ˜Ž
Fact
The time spent by the CD and his/her non-clinical leads are not fully supported as the job is virtually full time . How can a GP yet with clinical commitments to own surgery focus and concentrate on the directorial role ? Of course , the CD could be a non-clinician .๐Ÿ˜ณ
Fact
Resources provided by the system are not just money but altogether with time(mentioned already ) and expertise and actual number of leaders available . This is particularly so on the matter of supervision as your article mentioned.๐Ÿง
Fact
PCN has been used as a political expedience for the government, the system including our secondary care colleagues to provide a politically correct โ€˜solutionโ€™ to all complex and deep-rooted problems culminated in NHS after a long period of underinvestment by governments . ๐Ÿ‘ฟ๐Ÿ˜ˆ

FACT : Easy said than done and yes , I am moaning ๐Ÿ˜ˆ๐Ÿ˜ณ
Vinci Ho
Clinical Director, Care Enterprise
GP Old Swan Health Centre , Liverpool
Liverpool LMC committee member
GMC 3483114

IDGAF . 13 July, 2021 9:55 am

“There are no facts, only interpretations”. Nietzsche.

Patrufini Duffy 13 July, 2021 3:43 pm

Observation: one PCN = one theoretical standardised person to deal with (CD) instead in truth, 5 autonomous Partners.

Thus: easier to control.
Thus: easier to dismiss.

Dentists wouldn’t do this in their right mind. Nor lawyers from different firms.

Not Arvind Madan 13 July, 2021 3:47 pm

Thanks for posting your details Dr Ho. The NHSE correctional dept will shortly be sending its goons to re educate you………

David Jarvis 15 July, 2021 11:53 am

Fact London weighting in no way matches the high cost of accommodation in that London.
As a chippy Northerner I am surprised by the hold London exerts on people when a better standard of living is available elsewhere and simply on accomodation costs a higher standard of living on NHS income.
My hope is that some more Drs realise that leaving London or leaving the UK is better for them and their families. The only thing that would drive change is if the metropolitan elite feel it. So sorry Londoners but collapse in your services may be the best thing that can happen for all of us.