'Clunky' PCN recruitment scheme could put patients at risk, GP warns

Forcing PCNs to recruit from a 'centrally prescribed' list of roles rather than allowing them to bring in staff to meet the needs of their local population risks driving up mortality, one of the architects of the network model has warned.

Speaking at a Westminster Health Forum conference on general practice priorities, Dr James Kingsland - who championed the primary care homes (PCHs) model on which PCNs are based - called the additional roles reimbursement scheme (ARRS) ‘a clunky way’ to expand services and suggested there should be more flexibility around the roles networks can hire.

Dr Kingsland said that the makeup of primary care network (PCN) teams should not be dictated by ‘external agencies’ but instead by those receiving and delivering care in communities - adding that a lack of clarity around what health issues need tackling could have serious consequences for patient outcomes.

His comments follow a report by the King’s Fund last week which found that ‘rigidity’ around recruitment and reimbursement rules had prevented networks from hiring staff they need - and that networks had been unable to integrate staff properly.

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Dr Kingsland said funding brought in through the scheme was 'a welcome resource’, but suggested it was being mismanaged. He said: ‘ARRS funding [is] a clunky way of building an extended range of services.

‘If we're going to really build teams, functional teams, against the local population health needs of an area, you need a different approach because the one-size-fits-all method may not be right for local communities, for example not everybody may need a paramedic.

‘We've got to allow diversity so that networks evolve to different sizes based on local needs, and they start to build teams not through ARRS directions but through factors which are important to their local communities… rather than a central prescription.’

PCNs will be able to recruit double the number of mental health practitioner roles during 2022/23, NHS England confirmed in an update last week. In total networks will be able to hire from a list of 15 different roles - triple the number when the initiative' began.

Patient outcomes

Dr Kingsland said that a failure to recognise networks' need to have greater freedoms around recruitment could lead to negative outcomes for patients. He said: ‘If we get this right, we know that team-based care is better than individual care.

‘If we get it wrong… we could actually see increased mortality. There are grave dangers in creating teams that don't have a clear direction and understanding of why they are forming around local population health needs.’

The recent King's Fund report said rigid rules meant PCN clinical directors did not always feel able to take risks with recruitment. One clinical director told the think tank that they had to 'turn down six very good applicants' because of confusion around rules.

GPonline analysis of official statistics suggest that less than half of the 26,000 new staff promised to general practice through the ARRS have been recruited at the halfway stage of the initiative.

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