Welcome to another edition of the Primary Care Support (PCS) newsletter from the Sackwell & Binthorpe ICS with me, Penny Stint.
Thanks to the PCN CDs and other clinical staff who responded to our latest ‘temperature check’ survey. This covered a wide range of issues from morale and wellbeing to attitudes to the latest PCN service specifications. The results were incredibly encouraging, so we thought we should share the highlights with you in this month’s newsletter.
Asked how happy they were in their work, a sizeable majority of GPs (14%) said they were either ‘slightly happy’ or ‘neither happy nor unhappy, just numb’. Of the remainder, 24% said they were ‘very unhappy’, while a minority (62%) reported feeling ‘completely miserable’, ‘desperate’, or both.
After adjusting for the effects of Covid, underfunding, Brexit, an ungrateful public, the Daily Mail and NHS England, we find GPs feeling considerably more optimistic about the future than at any time since the start of the pandemic.
Another bright spot was the level of enthusiasm for the latest PCN service specifications, particularly those that have been deferred. One respondent, who clearly couldn’t wait to get started on the targets for online consultations and avoiding admissions from care homes joked ‘just give us the money’. We understand your frustration – those of us on the ICS contracting reporting and assurance subcommittee (CRAS) are as keen to get going as you are!
PCN funding: a clarification
A few of you (93%) raised concerns about the thresholds for Investment and Impact Fund payments. We put some of your questions to Neil Birch, director of strategy and finance for the S&B Integrated Care Board. He replied as follows.
‘As you may be aware, the IIF is one of a number of funding streams frozen until such time as the ICS has emerged from special measures and systemwide winter pressures have eased. While the intention is to provide an indicative budget for PCN funding equal or at least proportional to the sums anticipated in the technical annex to the national guidance, there may be some variance in the actualised figures subject to the Chancellor’s Autumn Statement, potential rises in food, petrol and wholesale gas prices, the triggering of Article 16 in the event of failure to renegotiate the Northern Ireland Protocol, and any resulting adjustment to RPI or the Bank of England’s base rate.
‘Even if allocations per PCN settle at the level set by the latest IIF guidance, that is between £120,000 and £180,000, we may, in the event of prevailing financial priorities, rely on the reserve powers detailed in subsection 13b of the forthcoming legislation permitting local adjustment of national service specification targets such that, for instance, the threshold for the mean number of contacts per patient in the weekly care home round in a given year were to be raised from 3-4 to 48-52, or that the percentage of patients reporting that it was ‘very easy’ to make an appointment in the patient survey were to be set marginally higher than the national threshold at, say, 98%.
‘In line with our commitment to stretch-targets, we endeavour to set system incentives just above your level of ambition or appetite for attainment. We know you wouldn’t thank us for setting expectations that were merely ‘realistic’ or goals that were always ‘possible’ to achieve. The ICS’s mission is to support all system partners to be the best possible versions of themselves.
‘The good news is that in the event of PCN threshold underachievement the ICS doesn’t ‘lose’ the money. The legislation makes provision for reinvestment of unused funds for strategic development purposes including leadership team building awaydays and provider partnership spa breaks. It goes without saying that we would only invoke this contingency as a last resort.’
Many thanks to Neil for that helpful clarification.
Mandatory training news
Another of the questions you raised this month also arose from the latest PCN guidance. Sally from West Loosely PCN queried why the 30-minute online training on shared decision making for PCN clinical staff was mandatory. ‘Shouldn’t we talk it through with someone, considering the pros and cons, before deciding whether or not to attend?’ she asked. The answer, Sally, is that you really need to complete the training to equip you with the skills to make an informed decision about it.
Russell from Betterton and Farcroft PCN asked what the ICS was doing to support GPs in the face of sustained attacks on the profession by parts of the media. We have taken a number of decisive steps including:
- A patient information leaflet that explains what GPs do and why they matter
- A hard-hitting social media campaign urging the public to be nicer to practice staff
- An appeal to local primary school children to draw pictures of GPs looking sad
- Letters to the RCGP and BMA seeking guidance, comms tips and posters
- An online refresher course on resilience for GPs presented by leadership coach June Lemon.
In the next issue we’ll look at how to keep PCN meetings down to under two-and-a-half hours and what to do with a difficult paramedic.
Penny Stint is primary care enablement lead for the Primary Care Support and Strategic Integration Unit (PCSSIU) at the Sackwell & Binthorpe ICS. As told to Julian Patterson