Primary care networks: 'Being able to work collaboratively is a real positive'

Primary care networks have been up and running for four months and clinical directors remain enthusiastic and positive about the changes they could bring, but they are also realistic about the challenges ahead. Rima Evans reports.

(Photo: John Wildgoose/Getty Images)

Primary care networks (PCNs) are just four months’ old and, while setting them up has involved a lot of hard work, many clinical directors feel confident that they represent a positive step forward for general practice and will address some of the difficulties facing the profession.

‘Becoming a PCN is a sensible move and practices now have the opportunity to employ and develop primary care staff other than GPs,’ says Dr Tim Cooper, the clinical director of Whitewater Loddon PCN in North Hampshire CCG, which is made up of three practices covering 38,000 patients. ‘For the first time we have new funding for this, which is crucial,’ he adds.

Dr Kelsey Boddington, clinical director of West Somerset PCN, which covers four practices and 33,000 patients, believes that PCNs will help general practice become more sustainable.

‘Being able to work collaboratively is a real positive,’ she says. ‘I work in a small rural practice. This new arrangement will give practices like mine a way of working at scale.  Being able to share multidisciplinary team members across a network, whether they be pharmacists, physios and so forth, will alleviate pressures on GPs and make a difference to our workload and working day.

‘In turn, this collaborative way of working should make GP recruitment easier. I think this is an exciting time, and an opportunity to redress the negativity that surrounds the profession.’

Dr Boddington says that for the practices she is working with, becoming a PCN was a logical and natural step. ‘A strength for us is that we were previously in a federation so have been working closely together for a number of years. It hasn’t been a massive shift for us to become a PCN and we haven’t had to work hard at bringing practices on board, or building trust.’

The challenges ahead

Despite the enthusiasm, clinical directors are realistic about the challenges their PCNs face during the next 12 months.

‘We had to work to launch the networks quite quickly,’ says Dr Amit Rastogi, clinical director at Leicester City South PCN, which has six practices covering 35,000 patients.

‘Understanding the policy, forming into a network, getting the right structure in place, appointing a clinical director and addressing issues such as pensions, all within a three-month period, was a challenge to manage on top of our day jobs. We were lucky that our practices had previously worked together and have good relationships.

'Even so, we will have to continue to evolve in the way we work together. Becoming a PCN will require a different mindset so instead of each GP partner thinking only about what’s best for their own practice or patient population, they will need to think about what’s best for the wider population and area.’

Dr Rastogi explains that for the first 12 months his network will focus on establishing a strong group, getting the practices working together as a provider group, developing leadership skills, and building relationships with a network of local clinical directors.

Another priority is assessing patient needs in an area that’s badly deprived. ‘We hope to set up systems and processes to gather data on our inner-city patient population that will help us assess the wider determinants of health that go beyond physical and mental health needs.’

Building relationships

Dr Boddington says that time is one of the biggest hurdles she faces over the next few months. ‘Freeing me up so I can carry out my clinical director role will be challenging due to my clinical commitments. We are in the process of recruiting an additional GP so my time can be released.

‘I also think creating headspace for GPs to come together to network and think about the needs of our population and how we can work with other organisations will be demanding. 

‘We are using "visionary workshops" to bring GPs together to work collaboratively on topics such as quality improvement work between practices, education delivery, and how work more closely with hospitals.’

Continuing to engage with all of the partners and create a sense of ownership of the network will also be vital, she adds.

Dr Cooper agrees that building trust and relationships will be key in this first year. ‘Our practices have worked with each other before but we want to promote transparency and build on those positive working relationships, drawing a line under where things may not have gone so well in the past,’ he says.

‘Our approach is to have an open book policy so everyone can see what our focus is or where the finances are flowing. It’s helped getting past that traditional GP mentality where we don’t share details about our practices because we are separate businesses. It can feel a little threatening to suddenly have to divulge everything.’

Involving staff at all levels

Involving staff at all levels of member practices is also important, says Dr Robert Weaver, clinical director of Mendip PCN in Somerset, which covers five practices and 36,000 patients.

He explains that to reassure practice staff about the new arrangement and explain a bit more about what being part of a PCN involves, Mendip PCN planned to hold an official launch event at the end of September.

‘The CCG has paid for out-of-hours cover so that our practices can close and we can all get together,’ says Dr Weaver. ‘The event is for all staff not just clinicians.’

Along with a social element, the plan was also to include breakout sessions so staff could discuss learning opportunities and potential ways to collaborate, as well as how the PCN could help build relationships across practices. ‘It’s a way of showing that we value our staff,’ Dr Weaver says.

‘There’s a lot of potential for PCNs to focus on making working life more sustainable for all staff,’ Dr Weaver says. 'It’s also an important aspect of ensuring we can retain existing GPs and attract new ones.’

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