Spring is a season of change, where we see the shoots and buds of what will be the flowers and fruits of summer and autumn. Similarly the NHS, this April, saw the start of the PCN contract and next month will see the formal start of integrated care boards (ICBs), subject to Parliament. Change and new beginnings can be seen as a challenge as well as an opportunity.
So, what does the future hold for PCNs and at-scale primary care collaboration? How do we build on the foundation our networks have laid in their first three years, while being realistic about what is achievable? How do we continue to inspire and support colleagues to flourish and innovate, and not be overwhelmed by the day job with its rising demand and complexity?
There is no quick answer. Being honest with ourselves and colleagues about the challenges is important. Using the collective talents in our networks will be critical for future success. However, as we start our fourth year as networks, I feel there is much to be hopeful about: working with neighbouring practices and local community care teams, sharing best practice, bottom-up innovation, new roles and additional investment in networks.
Although there is a wide spectrum of challenges with the 2022/23 PCN contract, there are many elements to support the long-term sustainability of primary care, while helping our patients and communities. For instance, this year’s £280m uplift in additional roles investment, with the hope we see 21,000 full-time equivalent (FTE) additional roles in PCNs by March 2023. Nowhere else in the NHS will we see workforce numbers rise in such a short time, with the aim of creating a wider MDT approach to primary care.
Sadly, this will not be a quick fix to primary care workforce issues as colleagues from the additional roles reimbursement scheme (ARRS) require support and supervision – for many this is their first role in primary care. But if we hold our nerve and embed these roles they should bring a new way of working in the longer term.
The ongoing investment in primary care clinical and non-clinical leadership in networks is key to future success, to ensure primary care at scale has a strong voice in developing places and systems as the health and care landscape shifts. Whether supporting care-home residents through the enhanced care in care homes specification or addressing PCN health inequalities, the at-scale collaborative approach brings economies of scale that will be good for the populations we serve, and should reduce demand.
Will this fix all of today’s problems? No, but it does give a solid foundation for the future.
This isn’t something our networks can do alone. We need to ensure they are supported nationally, and at a system and place level, now and in the future. We await the Fuller Stocktake to see what system-level support will look like.
We need to make sure our networks and primary care provider collaboratives develop a strong collective voice. Primary care’s voice at a system level remains critical for the success of any integrated care system (ICS) because if primary care fails, the NHS fails. We must remain open to the wealth of opportunities that PCNs offer us and our patients and to developing solutions together.
Dr Pramit Patel is chair of the NHS Confederation’s PCN network and GP clinical director for Care Collaborative PCN, Surrey Heartlands