NHS England targets for PCNs trigger backlash from GPs

New targets for primary care networks (PCNs) have triggered 'major pushback' from GP clinical directors leading the organisations, a top London GP has said.

NHS targets (Photo: Universal Images Group/Getty Images)

Dr Katie Coleman, a GP partner in Islington and Islington CCG governing board member, said network leaders in her area had reacted negatively to new short-term objectives set by NHS England and NHS Improvement in guidance published in August.

Speaking at the NHS Expo conference in Manchester, Dr Coleman said PCN leaders thought they had enough work on their plates - establishing new working relationships and employing additional staff - without being burdened with further goals.

‘Often we talk about what we expect of [PCNs]. Many of you may have seen the development support prospectus document to support PCNs to develop and within that they talk about what we should expect to see our PCNs delivering by March 2020.

GP workload

‘There [has been] huge pushback on that because many of our clinical directors and many of our PCNs are feeling that we already have a lot to do [in the] here and now.’

The prospectus, written to help PCNs ‘thrive and mature’, lists targets that clinical directors and their teams should achieve by March next year.

The targets include PCNs being expected to be ‘making 100% use of their funding entitlement for additional roles’ and to have ‘agreed multi-disciplinary teams with community provider partners’.

PCNs must also have ‘started thinking about their future estate needs’, have started work on a 'service improvement project' and join a network of PCNs to inform strategic health partnership or integrated care system-level planning.

PCN targets

Dr Coleman said PCNs were already expected to ‘sort out extended hours access’ and ‘put in place practice-based pharmacists’ under the new network DES, introduced earlier this year as part of the five-year GP contract deal.

She said it would be wrong to underestimate the ‘huge amount of work’ that would be required of clinical directors. ‘This is a real step change for general practice,’ she stressed.

Despite this, Dr Coleman said there was 'a palpable sense of positivity' around PCNs, with practices excited about working together.   

In addition to these short-term targets, NHS England has set five key long-term goals that look hugely demanding - including stabilising the GP partnership model.

Last month, GPonline reported that two thirds of GP partners believed PCNs would fail to deliver on any of their core long-term targets. GPs also said the targets would create additional work for clinicians, potentially worsening workforce retention problems.

Realistic expectations

Responding to the comments about ‘major pushback’ on the short-term targets, NHSE director of transforming health systems Dominic Hardy - who helped draw them up - said the goals were something to work towards rather than being a tick-box exercise.

‘I think there is a balance between being ambitious about what primary care networks can achieve… [and] being realistic about expectations over a given timeframe.

‘We put out the development prospectus primarily as an aid. I think if people read it as "tablet of stone" or "must dos", that’s probably the wrong frame for this. We are trying to give some sort of guide for where people might aspire to be.’

Mr Hardy admitted there would be variation in the success of PCNs, but said leaders had to work at their own pace.

‘If you have a network where people have barely worked together before, where they have a really unformed relationship, of course it’s going to take longer to build the kind of trust that is the essence of those networks over time.’

‘Given we’ve got over 1,200 networks, we’re going to have a really broad spectrum, probably broader than any spectrum we’ve worked with in the NHS before’.

Newly-appointed primary care medical director Dr Nikki Kanani said NHS England was trying to give PCNs gentle encouragement, rather than dictate a routemap for success. ‘We are trying really hard as a national primary care team to give the information that is necessary and no more than that, so people can co-create their solutions and think about their own development,’ she said.

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