Primary care networks (PCNs) will need more ‘authority’ and ‘flexibility’ to effectively prepare for a second wave of Covid-19 infections, an NHS Confederation report has warned.
The report, which marks the one-year anniversary of the introduction of PCNs, said that a ‘one size fits all’ approach to tackling upcoming challenges ‘will not be effective’, given the ‘huge variation in demography across PCNs’.
Instead, clinical directors need flexibility to design and deliver services that meet local demands, it said.
Prescriptive list of professions
The report found that many PCNs have successfully recruited professionals through the Additional Roles Reimbursement Scheme (ARRS), which currently provides funding to support the recruitment of clinical pharmacists, social prescribing workers, physician associates, physiotherapists and paramedics.
However, it argued that networks should not be forced to choose from a prescriptive list of professions and should instead be able to use funding to recruit ‘whichever roles’ they feel will benefit local needs.
The report also found that the ability of PCNs to take advantage of ARRS staff has been ‘variable’, in some cases because of a lack of time or resources to supervise and make best use of them.
This issue was also highlighted in a recent report from the National Association of Link Workers, which found that almost a third of social prescribing workers are considering resigning in the next year due to a lack of support.
The NHS Confederation report also said there have been issues around recruitment, as some areas have fewer available professionals to fill roles. Also, funding has not been weighted, for cities such as London, which have higher living costs, affecting PCNs’ ability to attract workers.
The use of the scheme has however helped to ease workload pressures, the report said, and ‘multidisciplinary teams have generally been effective in improving patient care and using the expertise of the wider NHS and voluntary sectors, as well as local authorities’.
Some clinical directors have also called for specifications in the network contract DES to be revised as a result of Covid-19, to enable more local autonomy, according to the report.
It said that NHS England and NHS Improvement should show leniency when assessing PCNs against the first years of the DES service specifications, which will be implemented later this year, because staff fatigue will continue to be an issue.
PCNs also want to have a ‘voice at national level in determining their own future’, and to have a central role in local plans to ‘reset’ healthcare after the pandemic, the report said
The opportunity for policymakers to hear directly from clinical directors about their experiences leading PCNs would ‘improve’ decision-making, it added.
‘Improved local relationships’
The report found a mixed picture of the progress PCNs have made in their first year, with some networks doing better than others to collaborate effectively and deliver improved local health.
Many PCNs have expanded their use of technology, particularly during Covid-19, which has helped to improve communication within and between networks, especially in rural areas, where practices are geographically far apart, the report said. The pandemic has also opened the door for more remote consultations, which can ‘allow for more patients to be seen’.
PCNs have also improved local relationships in primary care significantly, with ‘some stakeholders reporting that before PCNs there was little or no interaction’ between practices and with other providers, the report said.
Workload has been a key challenge for networks in their first year of existence, the report found, with this being ‘heavier and more stressful than many anticipated’ and exacerbated by the Covid-19 pandemic.
‘We have also heard that CCGs’ support during Covid-19 has been variable and in some cases quite limited for many PCNs. This has made dealing with issues such as personal protective equipment (PPE) and shielding lists more difficult,’ it added.