PCNs have become 'mini primary care trusts' with inadequate support

Management funding for PCNs is ‘completely inadequate’ to support GP clinical directors managing growing budgets and primary care teams, the NHS Confederation has warned.

GPs in PCN roles need support (Photo: sturti/Getty Images)

Details of the 2022/23 GP contract published by NHS England last week show that clinical directors will be given an additional £43m leadership and management payment ‘to support core running' of networks.

However, NHS Confederation director of primary care Ruth Rankine told GPonline that the funding package is still insufficient - with more money needed for practices to bring in backfill to cover for GPs spending more and more time in clinical director roles managing increasingly complex networks.

She added that a leadership programme for PCNs should be established as networks become closer to 'mini primary care trusts', warning that failure to do so could lead to missed opportunities to improve patient care.

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Exhausted GPs could quit PCN leadership roles amid doubts over funding

Calls for increased leadership and management funding come as clinical directors warned in February that they were feeling ‘exhausted and apprehensive’ ahead of the 2022/23 financial year, which will see PCN work ramped up.

The extension of the £43m for leadership and management, in addition to the existing £44m planned for PCN clinical directors as part of the five-year GP contract deal, brings the total clinical director funding pot for 2022/23 to £87m, according to BMA guidance.

The coming year could prove a key moment in the future of the networks, as CCGs are phased out and after the BMA said earlier this year that practices should consider whether to quit PCNs after NHS England unilaterally imposed changes to the GP contract for 2022/23.

Practices also face intense financial and workload pressure in the year ahead and could be unable to spare clinicians' time to focus on network roles.

Management funds

Ms Rankine said that funding for management infrastructure was severely lacking and unreflective of the task ahead for PCNs. She said: ‘I think if we’re talking about PCNs moving to become bigger organisations or legal entities, as some are doing, then I think you need to properly look at the leadership and management structure.

‘If you look at the budgets that PCNs are now holding, the number of staff that they’re employing - they are effectively mini primary care trusts, and that needs a properly funded leadership and management infrastructure.

‘What we have now is completely inadequate if we want PCNs to be a success and to deliver better patient care and innovation as was originally set out. We need to invest in the leadership and in the development of that leadership through an effective leadership programme.’

Ms Rankine suggested that funding and supporting proper management infrastructure would keep clinical directors happier in the role and provide them with much needed space to share learning.

Clinical directors

‘There are leadership development offers available for primary care in many areas of the country. But the problem is clinical directors don’t always feel they have the time to commit to these because of the pressure of the day job – they don’t feel they can take the time out - someone has got to cover their absence. That’s the challenge for primary care’.

Clinical directors told GPonline in February that they were spending double the amount of time on PCN work than they were paid for because of huge workloads - and this was before expanded service specifications started on 1 April.

London GP Dr Farzana Hussain recently stepped down from her role as co-clinical director at the end of March due to issues such as top-down management, endless meetings, and restrictive recruitment rules.

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