‘All our GPs are flat-out, I put my hands up at that; none of them have got extra capacity, so this was partly born out of need.’
They often say that strength comes in numbers, and clinical director of East Cornwall PCN Dr Penny Atkinson has certainly found this to be true in recent years. Facing capacity and recruitment issues at her surgery in Liskeard, south east Cornwall, it soon became apparent that others in the area were experiencing similar difficulties.
Agreeing to come together with a core focus of improving GP resilience, Dr Atkinson says that working as a network 'has been a real positive', with practices 'stepping up' to support their neighbours. The hard work is starting to pay off and, along with improvments being seen in practices, her network was named PCN of the Year at the NAPC awards last month.
Dr Atkinson says it was ‘a huge honour’ to be recognised for the award, but admits operating as a primary care home site prior to July 2019 - the month PCNs came into being - provided the network's practices with a solid foundation. She says it was ‘a logical step’ to form a PCN across the same geographical footprint that had been used the previous model in order to build on the work they had already done.
Working at scale
With a patient population of 105,000, East Cornwall PCN is one of the larger networks in England. However, it is divided into three sub-groups each with its own clinical lead who help with the day-to-day management of the practices in their area; this allows for 'much more agile' work, according to Dr Atkinson.
‘The whole point of this is that we didn't want to have layers and layers of management, which would take clinicians’ time away. And, because we already had something that worked in our locality - something which worked very well - we decided to keep that functionality we already had.’
With nine practices spread across a large area, Dr Atkinson says the health problems in the area are diverse and each sub group has different clinical priorities. Consequently, she says 'test and learn initiatives' have been crucial in efforts to introduce changes across the whole network.
‘We will try a new idea in one practice and once we have the model we'll move it out to all of them. Although we have some individual needs of each of the areas, we share practice.
'There are lots of other things that we are looking at, like backroom functions, to test at scale and make the whole thing more efficient,' Dr Atkinson adds.
The network has successfully merged practices’ medical record systems, while having access to a larger data set has allowed the PCN to focus on tackling high rates of diabetes - a real problem for the area.
Closer working has also allowed practices to improve patient access in innovative ways. As a rural community with some small practices, Dr Atkinson says surgeries have struggled to recruit GPs, but working collaboratively has allowed practices to explore new ways of addressing this, including investing in IT solutions and employing new staff roles..
'Because of at-scale working we've been able to procure things, such as LIVI consultations. We've had a little bit of bargaining ability because we were able to look at things on a wider scale. And not only in our network, but we've been able to do that with neighbouring PCNs as well and support them which has been really good… so you actually get a little bit of strength in numbers and that helps.'
Dr Atkinson says using video consultations in the practices has benefited both staff and patients. Using a system that provides extra capacity has helped ease GP workload and the system has also proved popular with patients in the most remote parts of the area.
In terms of additional staff, the PCN has already employed one full-time pharmacist and a second is on the way. With the majority of practices in the PCN being relatively small, Dr Atkinson admits that individual surgeries would not have been able to take on a full-time pharmacist on their own. However as a network, practices have been able to share the financial cost, with pharmacists working between surgeries.
Dr Atkinson says the pharmacist in place has already had a big impact, helping free up GP time and bringing additional expertise to the practice. ‘The practices where they are based have seen the benefits; they bring a huge amount to the table,' she adds.
Although first contact physiotherapists will not be funded by the network contract DES until April 2020, East Cornwall PCN introduced the role over a year ago, with each practice having them for one or two days a week. Dr Atkinson says that this role has also helped to reduce GP workload, with physios seeing patients who would previously have required a GP appointment first.
The PCN has also reached out to engage with community pharmacies, looking at ways it can collaborate with pharmacies which benefits both parties. ‘We put everyone in a room and actually worked out objectives and how we can support each other, for example we've collaborated over our flu season this year.’
With PCNs just a few months old, Dr Atkinson says there is a long way to go, but feels positive about the progress her network has made.
'We've been quite grown up about the conversations we've had with the CCG and they've actually enabled a lot of this to happen because they've allowed us to try things and are happy to let us run with it. And that's how we can move forward - we have to be allowed to try and do the right thing.'