The ‘PCNs: Two Years On’ report from the NHS Confederation's PCN Network - based on polling of more than 150 clinical directors - found 96% were taking on more work than they had anticipated, resulting in ‘fatigue, burnout and insufficient time for PCN development’.
Clinical directors admitted they were struggling to balance strategic and operational demands alongside their clinical commitments - and added that a backlog of care created by the pandemic had resulted in ‘capacity issues’ within PCNs and primary care.
Staff hired through the multi-million pound additional roles reimbursement scheme (ARRS) have brought ‘little reduction in GP workload in the first instance’, the report adds - explaining that ‘most patients are referred to ARRS staff by a GP’.
GP infrastructure
A ‘lack of infrastructure’, including issues with estates and IT, is also highlighted as a ‘limiting factor’ in the development of PCNs. Report authors said clinical directors are concerned about how they will accommodate their workforce, and offer patients face-to-face consultations with these new staff.
Almost all (98%) clinical directors say additional funding is required to develop primary care estates, while a 87% believe no new service specifications should be introduced in 2021/22.
The report does, however, highlight some positive outcomes of PCNs. It says that relationships with local partners are ‘much stronger’, and there is an increased awareness of health inequalities.
PCN Network leaders have demanded measures to help manage workload - including flexibility on service specifications in the 2022/23 network contract DES. They also call for improved funding to support PCN leadership and management.
COVID-19 impact
Overall, the report concluded that COVID-19 and the vaccination programme had both ‘interrupted and altered’ the development of PCNs, although many had made headway.
On the impact of additional roles staff, the report said: ‘The symbiotic relationship between PCNs and general practice means it is difficult to separate the two workloads...patients access both general practice and PCN services in the same way...this means PCN staff and services cause little reduction in GP workload in the first instance.’
It added that a wide variation in infrastructure between PCNs was affecting their ability to host their workforce and manage their population’s health.
Dr Pramit Patel, chair of the NHS Confederation’s PCN Network and clinical director of Care Collaborative PCN in Surrey, said: ‘From the outset PCNs have had high ambitions to improve and expand the range of patient services for their communities, and despite the most difficult of circumstances they have faced over the last year and a half, they are rising to the challenge.
‘Colleagues are clear there is a way to go, but with the right resource and space, PCNs can be invaluable in getting the NHS long-term plan back on track in driving forward expanded and improved services for patients, enhancing out of hospital care and supporting people to stay well in the community. With a sizable elective treatment backlog and the population’s health having taken a hit during the pandemic, this agenda is more important than ever.’
Last month, the BMA asked ministers to push back PCN targets by at least one year to 'reduce additional workload burden for practices’ during the autumn and winter when they will have to juggle flu and COVID booster vaccinations, as well as tackle the care backlog.
GPs leading PCNs have also previously expressed a desire to have more flexibility over the roles they can hire to and additional funding to support the training of these new staff.
