Clinical directors told GPonline that their role is ‘ever-expanding’ and that they will need extra funding in 2022/23 to keep on top of workload, particularly as delayed PCN DES specifications kick in from April.
One clinical director insisted they believed in the PCN model and felt it was the right way forward for primary care, but admitted they were spending double the amount of time on PCN work than they were paid for.
Another labelled PCNs as ‘a force for good’, but said the role was only achievable at present because of a £43m top-up to PCN management funding provided in 2021/22. GPs leading PCNs have argued this extra funding must be extended and warned against ‘pulling the plug too quickly’.
The NHS Confederation has echoed these concerns, saying an absence of planning around funding beyond March is causing issues for PCN leaders, whose work has already been disrupted by the delayed introduction of integrated care systems (ICSs).
GPonline reported last week that general practice recruitment and access to funding was being affected by confusion caused by the suspended rollout, with NHS Confederation primary care director Ruth Rankine calling for more transparency around future changes.
The additional £43m - around £34,000 per PCN - was announced last August to support leadership and management in 2021/22. It came at a time when NHS England recognised GPs were working 'harder than at any time in their history'.
The funding has been used by PCN leaders in a variety of ways, with some choosing to hire extra staff to cover their clinical shifts while they have been orchestrating COVID vaccination campaigns. PCN leaders say the extra funding has proved essential - but it remains unclear whether it will continue into 2022/23.
Clinical director at Whitewater Loddon PCN in Hampshire Dr Tim Cooper explained how the funding had helped. He said: ‘It has effectively freed me up on Mondays, so I have an entire clinical day now which is covered by locums - and that allows me to run the vaccination campaign and carry out other PCN work.
‘Before the funding the role, which you should dedicate roughly two sessions per week to, was easily taking three to four. I'm much luckier now I've got a PCN manager in place who's probably been the best resource we've employed - that's really helpful - but it's still a lot of work for us.’
GPs were instructed at the end of last month to ‘restore routine services’ as practices have seen less demand for COVID-19 vaccines following a strong booster campaign. But clinical directors will soon see their workload increase again with the start of the personalised care service from April.
Dr Cooper urged NHS England to clarify whether it would extend the PCN management funding. He said: ‘Given the amount of rebuilding we need to do, and with the vaccination campaign unlikely to just disappear, I think it would be incredibly wise to review the investment in leadership in general practice.
Clinical director role
‘My worry is that if we go back to normal and the funding drops, then those clinical commitments that I need to do for my practice will takeover again and I will be stripped back to the bare bones in terms of what I can do as a clinical director, and we won't be able to accommodate any vaccinations.’
‘The vaccine programme as a case in point demonstrated that if you give people time, they'll give you brilliance; that really needs to be considered and shows health leaders shouldn't necessarily pull the plug on funding too quickly… The job is pretty intense for what it is and, if another opportunity presents itself, I may have to think about looking at other options,’ he added.
Salaried GP and clinical director of North Newham PCN Dr Martin Edobar also said the role was ‘challenging’ and emphasised the importance of the funding. He said: ‘Different PCNs used it in different ways but largely they use it to reinvest in their workforce and to help deliver the COVID-19 vaccines. Workload for clinical directors has increased considerably and having to balance those requirements with the demands of our clinical obligations is quite tricky.
‘I spend significantly more than two sessions a week doing the role, which really runs in the background of my whole week. I've got meetings throughout the week… that’s not even taking into account the fact that you’ve got to keep your eye on the workforce and the HR element of the role.’
Dr Edobor imagined the role was ‘a stretch’ for those without additional support and insisted increased operational support was needed. He said: ‘If we're expected to continue to deliver the vaccination programme, we need resources from somewhere because by April PCNs GPs will be delivering the vaccine by themselves using their own core funds, which I don't think we'll be able to do. We need dedicated, ring-fenced funding'.
GPonline reported last month that GP practices running COVID-19 vaccine clinics may soon be forced to stop delivering them completely as stuttering appointment numbers and high DNAs have left partners subsidising the service.
Assistant director of the NHS Confederation’s Primary Care Network Karen Higgins said PCN teams had ‘provided much-needed additional capacity’ during the pandemic and would need continued support. She said: ‘Not only do clinical directors continue to see and treat patients, they also work with PCN staff and a plethora of other local agencies to help lead their networks.
‘Delays to the creation of new ICSs coupled with the dissolution of clinical commissioning groups, with currently no replacement for back-office functions, has added to this workload. The lack of certainty around funding beyond March is also leaving many clinical directors feeling exhausted and apprehensive for the future.’
A report titled ‘PCNs: Two Years On’ published by NHS Confederation last August found that 96% of clinical directors were taking on more work than they had anticipated, resulting in ‘fatigue, burnout and insufficient time for PCN development’.
NHS England was approached for comment.