NHS focus on high-achievers could leave 'immature' PCNs behind

Primary care networks (PCNs) formed by practices with little or no history of working together could be left behind as the NHS pushes more 'mature' networks to develop faster, GPs and policy experts fear.

Bridlington PCN clinical director Dr Zoe Norris (Photo: BMA)
Bridlington PCN clinical director Dr Zoe Norris (Photo: BMA)

NHS England has confirmed that where PCNs struggle to spend available funding - for example to recruit staff - the money is likely to be handed to other networks within their CCG area where 'swift progress' is being made, to help them develop even faster.

Locum GP and clinical director of Bridlington PCN in Yorkshire Dr Zoe Norris warned that NHS England could see varying levels of success between PCNs if it failed to support networks formed by practices who were working together for the first time.

She said that clinical directors in PCNs like her own, who were starting from zero, had been left feeling slightly 'overwhelmed' during the first couple of months of the new arrangement because they had not been given a chance to find their feet.

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Meanwhile, PCNs made up of practices with pre-existing working relationships saw the reorganisation as a 'paper exercise’ and had been able to push ahead with work to achieve NHS England targets, leaving others behind.

Speaking to GPonline, Dr Norris said: ‘There is an assumption that, because all of the documents are signed, every PCN is up and running and completely ready to take on the world, but that just isn’t the case.

'There are some practices that are ahead of the curve and were already set up and working together, and have been really quick to recruit those extra workforce roles.

‘But, for your average PCN that is starting from nothing, that’s going to take a good six months at least before they actually see the benefit.'

Maturity

Dr Norris said that she felt there was a lack of understanding about how challenging the last few months had been for PCNs and clinical directors at the bottom of the maturity scale.

She feared that those PCNs were at risk of being ‘forgotten’ if too much attention was paid to fast-moving PCNs, adding the burden of extra responsibilities would be ‘counterproductive’ for those that were at the early stages of development.

She asked for PCNs to be given more time to build their connections and forge their identities.

‘When they are talking about massive contracts and massive procurement, and supporting secondary care, [it feels like] they have scant regard for your average PCN and your average practices who are just trying to get on with the day job, and I think that’s just going to be counterproductive,' she said.

‘I would feel much more comfortable to have a six-12 month pause and shunting of the timetable to allow things to settle down and allow the stability for funding to come through so that practices have a bit more time to talk about what they are going to do with their PCN, what do they want to do for their patient. It feels like we have not had that conversation yet.’

Network funding

At the NHS Expo conference this month, NHS England director of transforming health systems Dominic Hardy admitted that there would be variation in the success of PCNs. However, he insisted that PCNs and their leaders would be able to work at their own pace, stressing that short-term targets for March, which he had helped to set, were intended to support networks rather than as ‘must dos’.

But NHS England's plan to divert funding from PCNs that struggle to spend it to higher-achieving neighbouring areas has fuelled concerns that gaps could grow between PCNs.

Senior fellow in health policy at the King’s Fund Beccy Baird said she was really worried about the prospect of NHS England supporting high-achieving networks rather than focusing on reducing inequalities between PCNs. For areas struggling to recruit, or to afford the 30% contribution practices in PCNs are expected to make towards recruitment of clinical pharmacists, more support may be needed, she argued.

‘With such a large proportion of funding in the [network] DES related to additional staffing, there is a danger that those PCNs who find it hardest to recruit, or who can’t afford the 30% contribution, won’t benefit from the network contract. I think CCGs should consider carefully how they will invest any underspend, using it to ensure that they don’t worsen existing inequalities.’

PCN development

Speaking to GPonline, clinical director of Mendip PCN in Somerset Dr Robert Weaver said his network had been ‘fortunate’ that practices locally had worked together before, meaning that there was less work to do at the initial stages.

However, he argued that the targets set for PCNs within the first years were achievable and did allow time for PCNs to develop, meaning less mature networks shouldn’t be left behind.

‘I think that year one is not too onerous and it allows people to build those [working] relationships,' he said. ‘Obviously, if there’s not been any work done together, there’s a slightly greater investment in time that’s needed. But it’s definitely achievable in the same year.'

He said PCNs could cope if they 'keep an eye on future years and they use this time wisely, rather than doing the absolute minimum'.

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