Narrow PCN targets restrict GP focus on what patients really need, warns NAPC president

Specifications within the PCN DES are too restrictive and are blocking work to improve patient outcomes, the president of the NAPC has warned.

Dr Johnny Marshall
NAPC president Dr Johnny Marshall (Photo: NAPC)

Speaking to GPonline's podcast ‘Talking General Practice’, Dr Johnny Marshall said that PCN targets were not the work that practices 'really want to do' - saying GPs found them inflexible, while results had been 'mixed'.

Dr Marshall, who was one of the pioneers of the primary care home (PCH) model - a forerunner of the network model adopted across England - said that requirements in the PCN DES were making it difficult for practices to carry on with work begun under the PCH model. But he said that GP teams had no choice but to continue with PCN work to avoid missing out on much-needed funding.

He has urged health leaders to rethink the way the model is delivered, including how the success of networks is measured and how the additional roles recruitment scheme (ARRS) is delivered.

Service specifications

Warnings that PCN targets are too restrictive come a month after the BMA labelled the investment and impact fund (IIF) - a QOF-style payment system for PCNs - 'overly bureaucratic' and said it risked undermining quality patient care. Former NAPC president Professor James Kingsland has also warned that the ARRS is negatively affecting patient health.

The PCH model aimed to bring together health and care professionals in local areas to build care around the needs of the local population. Reflecting on the progress of practices who had successfully adopted the PCH model before PCNs were launched, Dr Marshall said: 'Some of them have found that the constraints of the PCN contractual requirements have made it difficult to do the primary care home initiatives…and they've almost been running the two things in parallel.

‘There's almost been a contractual PCN thing that they have to do, and they will do that because - let's be honest about it - it's attracting investment, much needed investment into practices, into PCNs and into those primary care services - there isn't really another way of doing that.

‘So they’ve been very pragmatic in accepting that they have to [work as a PCN] because that attracts resources. But what they really want to do is [the PCH] work…it would be great if those two felt like you weren't having to run them in parallel, and they became much more closely entwined.’

ARRS recruitment

Dr Marshall said that the impact of PCNs had been a mixed bag - suggesting that networks and those leading them hadn't been given enough support and time to get the best out of the model, which was introduced three years ago.

He said: ‘I think the impact to some extent has been a bit mixed [which is] a little bit predictable because it hasn't had all of the elements [it needs] and that then creates a sense of disappointment. But we need to remember that when we're developing these sorts of new models it takes years to reach maturity.’

Dr Marshall added that ARRS recruitment rules had prevented some networks from addressing health needs in their areas. He said: 'I think that is a major bump, if you've got lots of varying health needs within the country, and a contract that doesn't have the flexibility to enable that, you're going to crash into [problems].'

Last month the BMA urged practices to consider pulling out of the PCN DES - arguing that changes imposed by NHS England for the 2022/23 contract asked PCNs to ‘deliver greater requirements than previously’; something which it said could affect ‘safe and effective care’.

Check the GPonline podcast page this Friday to listen to the full interview with Dr Marshall.

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