Smothering PCNs with early targets could stop them improving care

Primary care networks (PCNs) will fail to improve patients' lives if they are ‘smothered’ with objectives in their infancy, NHS leaders have warned.

Early targets threat to PCNs (Photo: alexsl/Getty Images)
Early targets threat to PCNs (Photo: alexsl/Getty Images)

Although national targets and goals will need to be set for specific clinical priorities, networks and other local NHS organisations must be able to 'drive a local agenda forward', an NHS Confederation report warns.

Integrated care systems (ICSs) will need to explain to local people why 'managed difference' between local areas can be beneficial - and why it is not the same as a postcode lottery.

But the report warns that networks could be unable to focus on local priorities if they are overloaded with targets during the early stages.

The warning comes after GP leaders voted last month to reject a package of contract changes for 2020/21, including five controversial service specifications for PCNs which were labelled as ‘totally unrealistic’.

GP contract

Feedback received in a three-week consultation on draft network DES plans raised concerns around PCNs' capacity to deliver them and the ‘pace and scale’ of what was expected of them.

The report, informed by a roundtable discussion between NHS health and local government leaders about integrated care systems (ICSs), argues that PCNs are not yet fulfilling their role as ‘the voice of the patient’ within local healthcare systems.

Participants in the discussion called for the creation of new structures to allow ICSs to support PCNs and bring about closer working.

The report said: ‘PCNs and integrated care partnerships (ICPs) should be used to drive forward an agenda of improving the lives of local people. However, they should not be “smothered” by attaching too many objectives to them at an early stage.

‘PCNs are also not yet fulfilling a role within systems as the voice or representative of the patient, and therefore the patient voice was not as yet successfully represented within the system, in many cases.’

PCN development

NHS England and Improvement (NHSE&I) confirmed last week that it was preparing ‘a significantly reworked set of service specifications’ following widespread criticism of draft plans. The BMA's GP committee is expected to vote on fresh proposals later this week.

BMA GP committee chair Dr Richard Vautrey said PCNs could not be expected to solve all the problems facing the profession and the wider NHS - particularly if concerns around workload levels were ignored.

‘PCNs have the potential to reshape general practice, but this is a crucial time in their development, and we need to see them given the adequate funding and support, along with realistic goals, to ensure they thrive for patients both now and in the future.

‘This is especially relevant given concerns around recently-published draft service specifications from NHSE&I, with clinical directors becoming increasingly worried about delivering what has been specified, even with the planned workforce expansion.’

A recent BMA poll found more than a third of PCN leaders said support they had received from their area's ICS or sustainability and transformation partnership (STP) was ‘poor’.

Realistic expectations

Director of the NHS Confederation’s PCN Network Ruth Rankine, said: ‘PCNs are a core building block to the future of health and the NHS and allow a much wider range of services to be delivered outside of hospitals to populations of between 30,000 to 50,000 people.

‘One of the key asks of our recent survey of clinical directors was that PCNs should be given more time to build relationships and prepare effectively for new service specifications. We are pleased that NHSE&I have listened to the concerns of clinical directors. This means being realistic about the pace and scale of what is being asked of them.’

Former chair of the National Association of Primary Care (NAPC) Dr Nav Chana told GPonline last month that 'top-down' draft DES specifications threatened to put off 'large tracts' of GPs

Dr Chana, who helped develop and roll out more than 200 'primary care home' sites across England that helped inspire the PCN model, also said the draft requirements created ‘lots of expectations in a quick timescale’, which risked undermining the efforts made by PCNs so far.

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