Locum GP and clinical director of Bridlington PCN in Yorkshire Dr Zoe Norris revealed that PCN leaders she had spoken to were already feeling overwhelmed by their new responsibilities - and warned that some could drop out if they did not receive adequate support.
Speaking to GPonline about the work being carried out by clinical directors, Dr Norris said: ‘Some are already feeling overwhelmed and under-supported. [Their PCN work] may not be affecting patient facing work that much, but it certainly will be increasing the pressure behind the scenes when it comes to things like QOF and managerial work.
‘I think it very quickly begins to feel as though you are being pulled in every direction as a clinical director at the moment, so I think [we] need support from LMCs and CCGs to try and streamline communications, and to step back from STPs, and really protect what’s happening.
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‘Your risk otherwise, is that people will just walk away from this. If you don’t get that engagement at the beginning, it will fail.'
The networks, launched in July, have grouped neighbouring practices across populations of between 30,000-50,000 people and are intended to ease pressure on GPs by recruiting pharmacists, social prescribers and other staff, as well as improving collaboration across the local health service.
Despite being operational for barely three months, there have already been indications that some network leaders are starting to feel the pressure, particularly around increasing workloads.
PCN targets
Earlier this month, GPonline reported that new targets for PCNs had triggered ‘major pushback’ from clinical directors in North London.
Speaking at the NHS Expo conference this month, GP partner in Islington and Islington CCG governing board member Dr Katie Coleman said network leaders in her area had reacted negatively to new short-term objectives set out by NHS England and Improvement, with GPs warning that they already had enough on their plates.
Meanwhile, in a Twitter Q&A session last week some clinical directors told NHS England director of primary care Dr Nikki Kanani that they were finding it difficult to manage their workload, with one network leader saying they had been left 'fighting for time'.
#primarycarenetworks @CdsPcn #worldpatientsafetyday The network development is feeling rushed & l am fighting for time as a CD. Once the1st priorities are clearer it will improve. Push for integrated care and popn health management now but this requires practices to work together
— Farzana Hussain (@fhussain73) September 17, 2019
It's feeling a little chaotic.
— DrGandalf (@drgandalf52) September 17, 2019
Trying to develop the network & relationships. But then lots of asks from @NHSEngland, systems and others wanting my time (+ resources).
Becoming a challenge to keep everyone on board tbh.#primarycarenetworks #WorldPatientSafetyDay
@CdsPcn
NHS England proposals to make PCNs the default option for maintaining services when GP practices collapse could also drive up workload for clinical directors.
GPC member Dr Fay Wilson called the plans 'sloppy thinking' from NHSE, warning: 'PCNs started off with quite a well-defined remit, but seem to be taking on more and more. I think if GPs feel overwhelmed people will walk away from them.'
Dr Norris warned that many PCN leaders had no capacity to take on extra responsibilities, especially with many working multiple roles.
Workload
‘Clinical directors, especially those who are practice managers, don’t have loads of time. The more that PCNs are asked to do and the more that brief expands the more that is going to be an issue. There is no slack in the system at the minute.'
She called for a ‘reality check’ on assumptions about how much clinical directors could achieve during the two clinical sessions per week they are funded for - and said PCN leaders had to be empowered to 'push back' on extra demands.
Dr Robert Weaver, clinical director of Mendip PCN in Somerset, agreed it was a challenge knowing how to find time for everything. He said his LMC had helped networks locally to sift through requests and allocate jobs.
‘A couple of times we’ve had a request from the CCG to go to a certain meeting and the LMC has played a role in collecting all of those requests, making sure that they are appropriate and then sharing them among the group of clinical directors,' he said.
Defined role
He urged clinical directors to learn from their neighbours, and to make sure 'their role is clearly defined, concentrating on what is essential first'. Dr Weaver argued that it was vital that clinical directors were enabled to use their clinical expertise in the role to support local GPs, rather than 'being just a manager', focused on service delivery.
NHS England medical director for primary care and London GP Dr Nikki Kanani agreed it was vital for PCN clinical directors to have the 'time and space' they needed to develop in the role.
She told GPonline: 'While we have had an energising start to PCNs, with a strong and diverse group of clinical directors, we must ensure they have the time and space to build relationships and focus on their core purpose.
'We have been clear that from inception on 1 July to April 2020, clinical directors should be supported to focus on their development needs and that of their practices, and not distracted by additional expectations.'
NHS England and Improvement also said it had provided funding to support clinical directors’ development, 'over and above' what is in the GP contract as part of this year’s PCN development funding.
