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Stop. Collaborate and listen

Covid has shown us the devastating results of not involving primary care in wider decision-making at an early stage. Speaking about the tragedy that befell care homes during the pandemic, Dr Ian Hall, one of the scientists advising the Government, said in the BBC2 documentary Lockdown 1.0: Following the Science: ‘We didn’t know how connected the social care settings were with the community… I’m sure there are lots of academics and policymakers that could have told us, if we’d asked them.’ This of course includes GPs, nurses and carers who know how care homes operate and the way agency staff move around. Listening to the people doing the caring is vital. 

In our latest roundtable, PCN leaders express dismay that the Enhanced Care in Care Homes service specification misses the importance of the relationship between GPs and care home colleagues. They suggest the DES should include measurements of, for example, the wellbeing of the care home staff and whether people are dying in their preferred place of care. This discussion highlights the disconnect between CDs’ experience and the demands from NHS England. 

So we can only hope that, with the advent of the new integrated care systems (ICSs), PCNs are given the voice they so desperately need. Let’s not forget, ‘evolution’ was supposed to be the buzzword of the 2012 Health and Social Care Act. But many felt the result was actually fragmentation. Now, the new Health and Care Bill is shooting for collaboration. Whether it scores remains to be seen. 

However, one thing that is already clear is… lack of clarity. PCN leaders are unsure how they will get a seat at the ICS table. There is an opportunity, and a willingness, from both sides, but how that is worked out is at a nascent stage. Many PCNs are still getting organised. And there is the ever-present pandemic. 

This should not be solely the responsibility of PCNs but I fear if they do not engage at a system level the opportunity could be lost. 

A report by the NHS Confederation, The Role of Primary Care in Integrated Care Systems, calls for greater support to allow primary care leaders to engage at this level. It also highlights that half of the 200 primary care leaders involved were unclear about primary care’s role at ICS level. 

Each PCN has distinct features. Some will have huge care home populations. Others, a large university. How to get representation of those localities and ensure primary care does not get lost needs to be resolved – and fast. Winter pressures and the Delta variant will put more strain on CDs’ already limited time. The PCNs that have funded a dedicated manager are the ones making progress. Similarly, it will be those PCNs that dedicate resources to working with their ICS that will ensure true collaboration across the system. You can’t have tens of PCN reps at board meetings but you can have a working group that elects representatives. NHS England should provide ring-fenced funding for this if the aims of the Government’s white paper, the ‘primacy of place’ and the PCN project as a whole are to be believed.

Victoria Vaughan is editor of Pulse PCN


David OHagan 1 July, 2021 2:47 pm

Any and all descriptions of ICSs are clear that they are not ‘big CCGs’
They do not intend to have members or to represent any group in the workforce.

Given this, it is clear that even if PCNs have a message for the ICS it will be one out of 4 to 5 voices. Acute care and the NHS commissioning board AKA NHSE are the two voices who’s shouts will be audible at the distance of an ICS.

The voice of PCNs however will be made of 40-50 disparate and conflicting voices, much easier to ignore than the community sector. Even public health and metal health will appear coherent in comparison.

PCNs are not constructed to be able to face this challenge, and already have more than enough ‘responsibilities’, some handed down, others voluntarily taken on.

ICSs have been developed to ‘get rid of Lanseley’ the key objection being that primary care had a say.

Those old enough to remember the time before PCTs and CCGs will be needed to understand just how wilfully blind the system can be to 85% of the work of the NHS.
That doesn’t include systems around referrals, and discharges, and follow up and….

Decorum Est 1 July, 2021 3:15 pm

..discussing which abbreviation ‘shuffles the deckchairs’, isn’t worth the ‘steam of….

Patrufini Duffy 2 July, 2021 3:51 pm

The Americans need you out of their equation. And this is the managers path for it.

Dave Haddock 6 July, 2021 1:13 pm

Difficult to have much faith in PCNs when having seen how they operate at close quarters.