PCN development undermined by lack of local autonomy, report warns

Primary care network (PCN) development is being undermined because they lack the flexibility to tackle local health needs and inequalities, network leaders have warned.

(Photo: Photofusion/Getty Images)
(Photo: Photofusion/Getty Images)

Work to improve health outcomes is ‘being overshadowed by contractual requirements’ for PCNs and ‘perceived tick-box exercises’ in the network contract DES, a report by the NHS Confederation warns.

Clinical directors and their teams ‘need to be given the freedom to fully use and maximise their competences’ to provide clinical leadership within neighbourhoods, the report argues - while heavy workload is preventing clinical directors from engaging with local stakeholders.

The report, which looks at the progress of PCNs a year after they went live in July 2019, warns that a ‘one size fits all approach’ approach could stifle innovation - particularly with regard to hiring staff through the additional roles reimbursement scheme (ARRS).

Workload pressure

Networks in areas including London had failed to recruit, exacerbating workload pressures, the report found. The NHS Confederation has called for greater flexibility around hiring - despite a widening earlier this year of roles that can be brought in by PCNs under the ARRS programme.

However, the report found that PCN progress had been sped up by efforts to work more collectively during the COVID-19 pandemic, specifically around digital transformation.

In February clinical directors warned that pared-back specifications for the network DES would still leave PCNs with excessive workload and take up ‘significant amounts of GP time’. GPs feared this would eat into time to allow practices to develop relationships.

The NHS Confederation report found 'a significant gap' between the most and least progressed PCNs.

Local autonomy

Speaking to GPonline, co-chair of the Confederation's PCN Network and clinical director of Fleetwood PCN Dr Mark Spencer said local flexibility had to be introduced to get the best out of networks.

‘One thing that will help PCNs to catch up is progressing local autonomy because there is nothing that speeds up development more than allowing networks to get on and do things locally, to be in control of the change that they want to see locally,' he said.

‘Even if things don't work out, you learn so much more from having the freedom to innovate, rather than being constrained within a national framework or national contracts.'

The NHS Confederation has called for leniency when assessing PCNs against the first year of the network DES specifications, warning this was particularly important in the context of the pandemic.

It also said that the ARRS remains restrictive for PCNs to address a ‘wide range of challenges’ in neighbourhoods.

Recruitment

PCN Network director Ruth Rankine also suggested rules should be relaxed to allow networks to focus on local problems.

‘We can understand why there are a set of roles and a set of specifications within the national contract because it's about bringing everyone up to a minimum standard. [But] if we are really to get into the heart of the needs of the local population, and really get into population health management, then we need to be able to design services to meet those needs, and recruit the right people to deliver them services, which may or may not be one of the roles within the ARRS scheme.’

PCNs with smaller teams were also found to have struggled more with workload issues, with some clinical directors worrying that pressure was sustainable. The report found many network leaders themselves have not had help with administration, leading to burnout and a high level of turnover. 

Ms Rankine added that clinical directors would need to be supported in order for PCNs to flourish. She said: ‘There's a massive challenge collectively in terms of how you support those clinical directors in their leadership to do what they need to be able to do, because I think if we get the leadership right, a lot of everything else falls into place.’

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