NHS England says it will avoid top-down approach to PCNs

NHS England will not issue national guidance to primary care networks (PCNs) about how they are expected to work 'unless there is a really good reason', a top official has said.

(Photo: georgeclerk/Getty Images)
(Photo: georgeclerk/Getty Images)

Ned Naylor, the organisation's acting director of primary care provider transformation, said NHS England wanted to 'be as flexible as we can' about PCNs and did not want to 'stifle innovation'.

Speaking at a King's Fund event in London on PCNs earlier this week Mr Naylor also said that it was important that NHS England did not 'overload' newly-formed PCNs.

'We are trying to get better at saying to systems that these are the things we need to do as an NHS across the country - some of these things come with detailed "this is how you must do it", but that is the exception,' Mr Naylor said.

'What we need to do is say you can design locally how you do it. So you can sit in Dorset and say we’ve got a set of resources, let’s think together as a group about how we best deploy those resources to improve care for people in Dorset, to improve health, to improve wellbeing. That’s the approach we’re trying to take.'

He added: 'That decision to be as flexible as we can and not issuing guidance unless there is a really good reason is a conscious one - we don’t want to stifle innovation.'

Establishing PCNs

Mr Naylor recommended that new PCNs should focus on 'the need to come together as a team' and to develop a vision for the future by 'looking at what the population needs and selecting areas to work together on a service improvement project'.

He suggested that PCNs should 'try to improve care for a particular group of people and use that to pull together to develop organisational form and all the other things that need to happen, rather than focusing on the individual aspects separately'. This would help networks to identify the organisational development support and leadership development that they needed, he said.

Mr Naylor added that NHS England was providing £1m of funding to STPs, over and above what is in the five-year GP contract, for them to spend on supporting PCNs in the early stages their development. 'It is important that clinical directors and primary care networks have the time and support that they need,' he said.

GP Dr Nigel Watson who led the GP partnership review and was also speaking at the event, backed NHS England's approach to less guidance.

'I think NHS England has taken the right line with this,' he said. 'They've said "if you want more guidance we'll give it to you, but do you really want it?" I think we want the freedom to innovate and ask for forgiveness and not permission. We need to get on and do it and own it.'

Expectations of PCNs

However he cautioned that the NHS needed to be reasonable about its expectations of PCNs. 'I think primary care networks are everything to everybody,' Dr Watson said. 'I've head they are going to solve every problem in the NHS. If we dream of that, they're not going to get off the starting block.'

NHS England has previously said that it expects PCNs to 'stabilise' the partnership model by taking 'responsibility for securing a new generation of partners'. If this did not happen, the profession could 'become salaried to other NHS providers' by 'default', according to an NHS document published at the end of June.

This ambition was top of a list of five priorities NHS England wants PCNs to achieve by 2023/24. It also expects PCNs to grow the wider workforce by over 20,000 additional staff; become a proven platform for further local NHS investment, including in premises; 'dissolve the divide' between primary and community care and achieve 'clear, quantified impact for patients and the wider NHS'.

At the King's Fund event this week Mr Naylor said he saw PCNs' main objectives as delivering a range of more integrated services to better meet the needs of local populations, helping to deal with the pressures facing general practice and providing a stronger voice for primary care within local healthcare systems.

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