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Primary care networks: a new way of working

14 May 2019

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The deadline by which practices must join a primary care network (PCN) is just a day away. Chris Davies, transformation partner at NHS Arden & GEM CSU asks if you are ready for the changes this will bring. 
 
PCNs will see practices and other health and social care organisations working in clusters to support patient populations of 30,00-50,000 people. The intention here is to incentivise joined up working, based on common sense collaboration between organisations providing health and care services across a specific area. So far, so logical.
 
But, as with any change affecting a complex service, PCNs bring challenges too – including data sharing, workforce planning, governance and finance.
 
So, what have we learned so far and how can that be used to support networks in deciding how they will operate by 30 June, when the PCN model must be defined?
 
NHS Arden & GEM CSU, Capsticks and clinical director for the national primary care home project, Professor James Kingsland, have been working with a number of emerging PCNs in the southwest and, generally speaking, we have found that there is clarity on what needs to be done, but some debate about how best to do it.
 
How do you know which are the best governance and workforce models for your organisation; how will you manage relationships between the member practices; and what needs to be in place to enable the information and resource sharing required?
 
Not surprisingly, different organisations bring different skills and some networks are more advanced than others. To maximise efficiency and focus attention where it’s most needed, we’re encouraging PCNs to begin with an independent assessment of the decisions, processes and documentation prepared to date to highlight gaps and focus on key priorities.
 
An important part of this is looking at how they are able to take the principles of the PCN and translate these back into their own network, mindful of what they plan to prioritise and how they intend to work.
 
Some of the most common issues PCNs are wrestling with include:

  • Organisational structure: early indications show that there is much debate about what this should be and whether networks need a separate organisational vehicle from the outset.
  • Contracts and agreements: how to use the GP contract to optimise the funding available to PCNs and what agreements need to sit within this. For some that will be about tweaking an existing  memorandum of understanding, for others it may require more detailed work to prepare the network agreement schedule that sets  out roles, responsibilities and expectations for each organisation. 
  • Trust – much will depend on the maturity of the relationships and the level of trust between practices. Issues such as risk-sharing, access to shared staff and resources, and accountability are of greater concern to emerging networks that don’t have a track record of working together.
  • Culture and leadership: if the culture is right then networks will flourish. However, there are networks coming together in areas where practices have not previously worked together. Creating an environment where trust and collaboration underpins decision-making is more challenging. Organisational development, the use of mentoring and coaching approaches must therefore be seen as a key priorities.
  • Integrated Care Systems (ICS): while much of the current focus is understandably on meeting the immediate requirements, some networks are already discussing how the PCN can be configured to make the most meaningful contributions to future ICS discussions.
  • Resources: how can organisations make the best use of their existing assets to resource and manage their PCN? What new workforce models should be considered and how can we engage healthcare professionals such as pharmacists and social prescribers?
  • Data protection and the use of summary care records:  what IT systems and digital solutions will be required within the network to allow patients to access different parts of the service? What do PCNs need to have in place to ensure systems link together while still protecting patient data?

These decisions require engagement across the network to understand and agree the PCN’s shared purpose, supported with appropriate governance.
 
Tomorrow is just the start of the PCN process – the networks are about long term gain rather than a quick fix. 
 
However, based on the conversations we’ve witnessed to date, there is a will to succeed in delivering joined-up care across local areas for the benefit of local population – which is encouraging.


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