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PCNs – a unified voice for the future



unified voice

Having reported on the NHS for over a decade, I am not surprised to see a new cycle of reorganisation. However, no one could have foreseen the emergence and impact of Covid-19.

Forged in this fire, clinical directors (CDs), leading the charge for PCNs, came together at unprecedented speed. In just months, they accomplished work that would have taken years. Practices swiftly set up their red/blue, hot/cold, Covid/non-Covid sites, working together to stop the spread – aided by the links already made in the PCN.

Now they are running vaccination sites and finding these are preferred by some patients. They are visiting homeless shelters to vaccinate underserved populations. They are on the phones, reaching out to hesitant vulnerable and deprived patients. All alongside their daily GP and PCN business.

Much of the thanks should go to PCNs – which are making waves, even though they are drowning in demands.

The inspiration for this supplement was the report I wrote for Pulse: Primary Care Networks: Controversy, Covid and Collective Working, on the state of PCNs after their first 18 months. Through the interviews, I saw recurring concerns: the size and scale of the task; the restrictive nature of the additional roles reimbursement scheme; and how PCNs fit into the system.

In fact, the publication of the White Paper, Integration and Innovation: Working Together to Improve Health and Social Care for All, signifies the increased importance of PCNs with the wider NHS. The 80-page precursor to the Health and Care Bill sets out the stall for the NHS, public health and social care system to ‘connect, communicate and collaborate’.

But contrast this aim with the Covid vaccine rollout – the disconnect between expectations and supply at mass vaccination sites, PCN sites and pharmacies – which PCN CDs discuss in our roundtable.

The White Paper mentions PCNs twice. The first is when it allows the formation of joint committees between commissioners and providers, which ‘could include representation from other bodies such as primary care networks, GP practices, community health providers, local authorities or the voluntary sector’. The second mention restates a commitment to the ‘primacy of place’, with ‘shared priorities’ and ’place’ as a primary focus for PCNs.

PCNs will have a vital role in shaping the agenda – if their voices are heard. Therein lies the challenge – working together across a single PCN is already difficult in some areas. Combining roughly 10 PCNs to create a unified primary care voice across the ICS board, while keeping local focus, will be no easy task.

ICS leaders I spoke to recognised the value of PCNs, which allowed them to manage the pandemic more effectively. The first two years of PCNs were defined by setting up and Covid. But as PCNs come into their third year they can embed the work they’ve done and focus on their future priorities to deliver agile and responsive care. But they must be supported and listened to – and I hope this supplement will help.

Victoria Vaughan is editor of PCN

READERS' COMMENTS [6]

Liam Ohara 15 April, 2021 1:38 pm

The PCNICS interlude is the latest manifestation of Alphabetti Spaghetti.

No credible attempt at a business model to stabilize and invigorate primary care has been described, just another tin from Heinz-57.

Stapling the morning chorus together doesn’t create a Phoenix.

The Kings Fund misinterpretation of the Nobel Laureate, Elinor Ostrom’s work sits at the centre of this insanity. Common pool resources [aka GP Businesses] like Trees/Fish and Water are resources to be protected not harvested into an Tourist spectacle such as Easter Island.

The enduring delusion of ‘we can make this work’ in the instance of PCNs satisfies Einsteins first and only Law of Insanity.

Hello My name is 15 April, 2021 9:35 pm

If nhse say they are successful for long enough, perhaps people will believe them.

The metric to judge the PCN model by is GP R&R. What happens to the FTE number of GPs over the course of their introduction. Most crucially, perhaps, what happens to numbers of GP partners? How does the trajectory look, and has the model done anything to alleviate the crisis? I suspect I could predict the answers.

Centreground Centreground 16 April, 2021 3:32 pm

PCNs were the expected huge disaster as was envisaged. It is clear to those who work within these wasteful organisations with Clinical Directors collecting thousands in taxpayers money and some being barely visible on the coalface that there are many individuals being paid astronomical amounts for attending unnecessary MS Teams meetings to justify their existence while the usual dedicated increasingly smaller group, who actually see patients do the real work on their behalf while they in some case continue to write write self congratulating monologues. PCNs are the biggest waste of NHS resources in NHS history!!

Samuel Liddle 18 April, 2021 8:05 am

It’s wonderful that you feel passionate about PCNs. I have a rather different viewpoint. I just see them as utterly pointless, sorry. The vaccine rollout would have been fine without them. Our hothubs ended up being CCG level endeavours, and ultimately PCNs not needed. The extra roles are sort of nice, but not really what we need at practice level which is: more GPs, and more services to refer to.

The larger an organisation gets, the more unwieldy is becomes. GP is not about at-scale endeavours and never has been. Already, PCNs are becoming overwhelmed with unrealistic expectation and workload. PCNs are problem creators, not problem solvers. GP has a model that works – small responsive practices, nimble enough to meet patient need. PCNs just complicated things.

Catherine Beanland 18 April, 2021 8:45 am

The vaccination program in my area has been a success thanks to individual practices and their managers making it so. PCN directors and PCNs have caused extra work and inefficiency. Communication has been poor, the lack of leadership has been dreadful. It is disgusting that PCNs are being congratulated for a program that has not been led by them, and not been organised by them at all.

David Mummery 18 April, 2021 9:54 am

Yes agree with Catherine – the vast, vast majority of the legwork for the vaccination programme is being done by individual GP practices, so NHSE should not be saying that it means PCNs are a massive ‘success’ simply due to this..