GPs, nurses and pharmacists who are responsible for leading networks of general practices in England want greater flexibility and autonomy to work in a way that is more responsive to their local populations.
A year on from their formation, primary care networks (PCNs) have said that delivering a broader range of services, which are more joined up, closer to people’s homes and tailored to local communities depends on them having greater control over the services they deliver and the roles they can employ.
The ambition for more integrated care outside of hospitals is a key part of the NHS Long Term Plan. While the rules on staff PCNs can employ (called the Additional Roles Reimbursement Scheme) have eased workload pressures for some, others have felt restricted in their ability to employ key roles to meet their own local priorities.
The findings come as the NHS Confederation’s PCN Network has reviewed how the first year of primary care networks has gone and what lies ahead for the next twelve months, based on the views of its members across the country.
In its report, the NHS Confederation highlights the benefits for the health of their local populations PCNs have delivered in their first year, but says that there needs to be a better balance between fulfilling contractual requirements and doing what is best for their patients, as well as more time to develop local relationships.
The network is calling for increased flexibility in how PCNs operate, greater support for clinical directors and involvement with system-level work to manage the health of the local population.
Ruth Rankine, Director of the PCN Network, which is part of the NHS Confederation, said: ‘The last 12 months have presented a real mix of opportunities and challenges for PCNs. The extent to which they have progressed has been contingent on good leadership capability, a history of strong local relationships and a clear vision of what they want to achieve. There have no doubt been obstacles, the greatest one being coronavirus, but in spite of and in some cases, because of these challenges, many have been able to make significant progress.
‘In particular, many PCNs have expanded their use of technology, allowing more patients to be seen remotely during the first phase of the pandemic, and to build strong new relationships with other partners across primary care and the wider system.
‘Looking forward, there will be new challenges for PCNs, but the pandemic has shown the value of collaboration and integration across health and care and so, there has never been a more important time for PCNs to be part of that transformation. To do this effectively, clinical directors and their managers need more time to engage in strategic decision-making, as well as greater freedom and autonomy to respond to the specific needs of their communities.
‘Only then will we retain strong leaders in clinical director roles and get the innovation in primary care that is at the heart of the NHS Long Term Plan and that we have seen a glimpse of in the response to COVID-19.’
PCNs were launched in July 2019 to bring general practices together with other primary care and community organisations in England to enable more integrated services for their local communities, which can span between 30,000 and 50,000 people.
They are seen as a core building block of the future of health and the NHS, and they are intended to allow a much wider range of services to be delivered outside of hospitals, as well as support care to be more joined up. Currently, there are around 1,250 primary care networks in England, with 98 per cent of general practices part of one.
Dr Farzana Hussain, co-chair of the NHS Confederation’s PCN Network and clinical director for the primary care network, Newham Central One, in east London, said: ‘The value of PCNs has really been demonstrated through COVID-19. We have heard from many clinical directors that the new relationships formed between practices within their PCN have been hugely beneficial in coordinating their local response to the pandemic.
‘Some have spoken of the PCN acting as a channel through which discussions can take place about the pooling of resources, including PPE. Equally, in areas where progress has been made in facilitating multi-disciplinary working, this has proved to be a real asset as PCNs deal with the management of shielding lists in co-ordination with the community and voluntary sectors.’
NHS Confederation. Primary care networks: one year on; 15 July 2020. https://www.nhsconfed.org/resources/2020/07/pcns-one-year-on