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by Clive Cropper
16 December 2020

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Does the size of your Primary Care Network really matter?

As Primary Care Networks (PCNs) come to the end of their first year Clive Cropper, retired practice manager, reflects on what components are vital to ensuring their future success 

A recent study undertaken by the National Institute for Health Research (NIHR) indicated that more than 40% of the 1,250 primary care networks (PCNs) included were not configured to the 30-50,000 population size recommended in the PCN DES policy guidance. In terms of PCN sizes, research showed that 58% met the policy guidance, 30% exceeded it, 5% had  populations over 80,000 and 7% were below the minimum recommended size.

In addition, the study also highlighted the challenges potentially facing PCNs regarding their provision of sufficient management support and the effectiveness of CCGs to support and work with PCNs following recent mergers.

Practical observations

For almost 20 years I worked as a practice manager in Cannock, Staffordshire, always with an interest in the ‘bigger’ picture. Fifteen of those years were spent working with committed clinical colleagues and managers with a view to developing partnership working with neighbouring Practices, local commissioners and other healthcare partners. The aim was to improve services for patients while at the same time, provide benefits for practices.

When clinical commissioning raised its head, in 2005/6, I helped set up the Cannock Chase Clinical Commissioning Consortium. At that time this comprised of 28 Practices across three localities, with a combined population of 135,000. The Consortium had a committee made up of GPs and practice managers representing and acting on behalf of the three localities, meeting monthly, sharing information and seeking the views of all of the practices. We also had, in my view, the closest working relationship with commissioners during that period, with an excellent primary care manager. The Consortium operated until 2012.

Following the reorganisation that resulted in the formation of merged Clinical Commissioning Groups, in 2012 and 2019, I was the lead manager for Cannock Practices Network, one of three locality networks introduced across Cannock Chase. It had 11 practices with a combined population of 63,000. Once again, the Network had a multi-disciplinary management committee with regular meetings and good communication and engagement, with practices and with patients.

In 2019, I oversaw the division of Cannock Practices Network to develop two Cannock Town Primary Care Networks, each with a population of approximately 32,000 – so, within the policy guidelines. The rationale behind this was to maximise the additional manpower benefits for the area and management support funding for the new PCNs.

‘A strong foundation’

So, what conclusions can I draw from my involvement with the three primary care locality organisations?

Firstly, irrespective of the size of the organisation’s population, service improvements have been achieved by all of them, either with the national priorities at the time, working alongside the statutory organisations or, independently, to satisfy locally identified issues.

To illustrate the point, the 100k+ patient base Commissioning Consortium oversaw the introduction of a number of practice-based services to reduce waiting times for patients and take pressure off secondary care. These included diabetes clinics, orthopaedic triage, minor surgery, spirometry, and contraceptive implants.

Similarly, as one of its business plan targets, the 64k patient base Cannock Network prioritised the reduction of inappropriate hospital MIU attendances, successfully bidding for Wave 2 Prime Minister’s Challenge funding to introduce an extended access appointment service.

Over a three year period, patient feedback indicated that over 4,500 MIU and A&E attendances were saved. Workload pressures in practice were also reduced due to the extra appointments offered by the service (26,500 over the three years) and patients were consequently seen sooner and in a more appropriate environment. Winners all round!

In terms of the current PCNs’ performance it’s almost certainly too early to judge at the present time, particularly as the bulk of their first year has coincided with the Covid-19 Pandemic. It is however, encouraging to note from the research study the view that PCNs have made encouraging progress. A repeat study, at some point in the near future, should make interesting reading.

For me, the driving force for success is to create a strong foundation from which to then achieve the targeted service improvements. The key elements for me are:

  • Build a focused and well-led multi-disciplinary team, consisting of committed clinicians and managers to run the PCN. Make the most of the variety of skills and knowledge that will undoubtedly be there.
  • Have a knowledge of the current local health issues affecting the locality.
  • Engagement and communication – with all practices, staff, and patients (Patient Engagement Groups).
  • Establish a ‘Plan’ that seeks to develop and improve local services and implement national priorities (10-year Plan, PCN DES etc).
  • Build a positive and committed two-way working relationship with the Local Commissioning Group, Integrated Care System etc.

Summary

The overarching theme throughout each organisational ‘reincarnation’ that I was involved with was a multidisciplinary approach, the provision of good management and administrative support, coherent, relevant planning and then delivering that plan. Over each period, MDTs and developments were supported, and at times led by practice managers, with support from PCT and CCG primary care managers.

PCNs need to ensure full representation from their constituent practices, both clinicians and managers. They need to ensure that decisions are taken as a consensus and participants feel that they have had the opportunity to be involved, express their views and ‘own’ the eventual decisions. PCNs shouldn’t be ‘listening’ shops with one or two individuals dictating the direction of travel. Engagement and communication are vital if service improvements are to be achieved.

My view from practical experience is that service improvements can result from organisations of any size, as we demonstrated across Cannock Chase over many years. More importantly for me is that PCNs Clinical Directors and PCNs recognise that good management support, in some shape or form, is not something that they can function successfully without.

Similarly, CCG’s need to really work hard to engage, support and help PCNs to deliver the daunting agenda that they have been given.


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