How are PCNs helping general practice respond to the coronavirus outbreak?

Many GPs have expressed scepticism about the role of primary care networks (PCNs) but general practice in some areas would struggle without them during the coronavirus outbreak, say clinical directors.

Practices have moved to total triage (Photo: JH Lancy)
Practices have moved to total triage (Photo: JH Lancy)

By exploiting the working relationships that PCNs have nurtured over the past eight months, clinical directors say that local groups of practices have been able to work collectively and react quickly to the COVID-19 outbreak.

In what’s been described as an ‘enormously challenging ten days’, GPs have said that PCNs - formed only last July - are helping surgeries to overcome staff shortages and protect the delivery of general practice amid self-isolation and illness.

One clinical director has said that working in smaller groups of practices, as opposed to larger structures such as CCGs, has given surgeries manoeuvrability during the pandemic - labelling the success of PCNs during this time ‘a happy accident’.

Meanwhile, other clinical directors have suggested that PCNs are working better because of a ‘change of mission’ during the coronavirus outbreak, which has seen them scale back work related to the network contract DES and instead focus on supporting each other.

Last week, PCNs were in crisis after LMCs voted for the profession to reject the network DES at a special conference of England LMCs. GPs raised concerns about the lack of funding for networks, the workload involved and highlighted fears that practices' long-term financial survival could end up dependent on their involvement in networks.

PCNs have key role

However, in many parts of England, networks have played a key role in helping to organise and support general practice to respond to COVID-19. Speaking to GPonline, clinical director of Newham 1 PCN in east London Dr Farzana Hussain admitted that practices would have struggled if they had been left to work in isolation.

‘To be honest, if we were not in a PCN we would be up a gumtree at the moment – who else were we going to ask for help? It was very easy for me to immediately say, well two of the practices are on the same telephone network, we kind of know each other, let's do it.’

Practices in her PCN have ‘buddied up’ into smaller groups which allows them to pick up consultations in the event that a surgery loses staff or has to close for cleaning.

Dr Farzana said that all seven practices had moved to telephone first triage in the last six days, with some having moved to total online consulting. Meanwhile, the PCN has used DES funding to buy laptops for staff, ensuring that people can work remotely during the pandemic.

‘Had PCNs not happened last July, we would all be scrabbling around. We were already on rung three of the ladder [ahead of COVID-19], so it has been easier to get to rung five and six, otherwise we would be starting from zero.

‘It’s ironic that LMCs voted to reject it and this happened because we would be dead without the PCN structure and support at the moment to be truthful.’

Clinical leadership

Clinical director of West of Waverley PCN in Surrey Dr Dave Triska agreed that PCNs were helping practices to organise themselves in his area.

Dr Triska, who is the regional lead for digital in his area, said that the pre-existing relationships between practices in PCNs had ‘made a massive difference’ during COVID-19 planning. He suggested working in CCG-sized groups would have been too complicated.

‘I think this has been a happy accident. I know this wasn't what they were intended to do but it's meant that you've had a pre-formed body of people who were already cooperating at a size that's functional.

‘In Guildford and Waverley we have 20 practices - I'm just trying to picture having 20 practices sat down in a room, trying to work through a plan for the neighborhood's about how they provide care for people in the situation. But that's easy to achieve with four practices in our network.

‘The big thing that PCNs are delivering now is some clinical leadership and there's a structure assigned which is a manoeuvrable structure.’

Delivering core services

Yesterday, NHS England wrote to doctors confirming plans to relax contract requirements for general practice during the COVID-19 outbreak, which also includes relaxing requirements for PCNs under the network DES.

GPs had, until then, highlighted a lack of communication from NHS bosses, leaving practices unsure of how to operate. Dr Triska said PCNs had been useful in discussing what services to provide during the pandemic. He suggested PCNs were working better after being given a ‘clear goal'.

‘The reason for PCNs being formed was largely about efficiencies in the NHS and making the most of limited money. The reason for PCNs operating now is to save lives, which a massive mission change, and a massive mission for primary care.

‘We have stopped doing all the stuff that the PCN DES was telling us to do and now we are doing what we should do which is core delivery and we're doing it really well.’

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