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9 April 2019

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‘Primary care networks are the bedrock of any integrated care system’

Valeria Fiore speaks to Dr Minesh Patel, chair of the National Association of Primary Care (NAPC) about how primary care homes and networks will drive the delivery of the long-term plan.

All patients are expected to be covered by an integrated care system (ICS) by April 2021, NHS England stated in the long-term plan.

However, when it comes to providing integrated primary care services to a local population, the task will fall to primary care networks (PCNs), which are expected to be up and running by July this year.

Dr Patel, who is also a GP, believes PCNs and primary care homes (PCHs) – a type of PCN modelled by the NAPC – will be essential for the delivery of the long-term plan.

‘I think it will be almost impossible for ICSs to exist without effective development of PCNs or PCHs,’ he says.

‘They are the bedrock of an ICS and it would not be possible for an ICS to sustain [itself] without the development of wider primary care.’

Past initiatives where work towards integration failed to involve primary care did not result in ‘a great deal of system or population benefits,’ Dr Patel explains.

This time around, PCNs should be enabled to take greater responsibility for their local population to deliver their ICS’s vision, according to Dr Patel.

However, he adds, that will only be possible if different parts of our health and care system collaborate to define which objectives will improve local population health.

‘Each organisation has its own targets but this is about creating an environment where we align some of them while making sure we are investing and incentivising people to do the right things, Dr Patel says.

However, he thinks it has become more difficult for healthcare professionals to get together and formulate an agenda over the last 10 to 15 years.

‘[It] has become harder and harder to [build professional relationships], partly because of the way our system is organised and partly because our professionals have gotten busier and busier’.

‘Develop from the ground up’

It is both NHS England’s and the BMA’s vision for general practice to take the lead in setting up PCNs, while commissioners have been instructed to intervene only to ensure every patient is covered by a network, as the BMA recently specified in a PCN handbook.

Dr Patel, who became NAPC chair in September 2018, supports this approach and says the organisation will work collaboratively with providers and local systems interested in setting up a PCH to make sure primary care staff lead the process.

‘PCHs have to develop from the ground up. While the planning guidance and the long-term plan [suggest how we should develop] them, we are very keen to ensure that as they start to evolve, they represent a population and want to work together in a way that improves population health,’ he says.

‘We want to [help PCHs develop from the] ground up and I am fairly confident that more groups of primary care providers will approach us to develop PCHs.’

Since their inception in October 2015, when the programme was launched by NHS England chief executive Simon Stevens, the number of PCHs has grown exponentially and today there are over 220 sites across the country.

Having gone above and beyond the original target set by NHS England – which asked the NAPC to develop around 120 PCH sites – Dr Patel says the organisation’s focus is now on the provision of high quality support to those who are developing sites, or who want to.

‘We are not targeting a specific number at this point but we are working with STPs and emerging ICSs to help them develop their PCHs,’ he explains.

‘We continue to get interest from various places across the country; some of that interest comes from the fact that ICSs are beginning to emerge and there is quite a bit of thinking around how [to] meaningfully engage with primary care providers and support that demand.’

Primary care homes are established primary care networks, and have been running for three years. Practices can choose the best arrangement for them to form a PCN and have not been recommended to follow any model in particular to develop their networks.

However, Dr Patel says that the PCH model comes with a number of benefits including giving providers the opportunity to access NAPC resources.

‘We have gained a lot of insight and experience into how to assist PCHs in their development. We have done a lot of work around how you can engage with the dental profession, pharmacists and other allied healthcare professionals and around the future [role] of practice managers.’

The role of the practice manager will, Dr Patel believes, be crucial to the network structure that all practices will in the future be a part of. 

‘We have established a diploma in practice management for the future generation of practice managers who will have to work at scale,’ he says. 

‘Practice managers are a key part of developing any service or structure. The [present] challenges are moving towards a system where we are working at scale so we have to evolve our management skills alongside.’

From cure to prevention

The long-term plan allocated £4.5bn a year by 2023/24 to primary and community services, funds intended to better care for patients in the community and closer to home.

There are a series of actions that can be taken at a local level to promote wellbeing and help patients stay healthy, some of which are being championed by PCHs, according to Dr Patel.

‘We spent much of the last 30 to 40 years fixing people’s problems. That has contributed to a lack of sustainability within the health service and local authorities services.

‘We really need to shift our focus towards prevention and wellbeing and that is where networks and PCHs will play a very prominent role,’ he says.

‘If you look at some of the PCH sites, they are promoting wellbeing, developing more peer support and supporting community networks for their residents; such as walking groups, choirs, and groups for people with long term health needs.

That improves people’s [health] outcomes and enables them to live better lives, [ensuring] we spend less money on more expensive healthcare.’

Team-based leadership

According to the long-term plan, all PCNs will have a clinical lead who will attend ICS board meetings.

However, Dr Patel believes the NHS should go further and base leadership around local teams. This, he explains, is because networks have a multidisciplinary team and creating hierarchies within them is detrimental to the development of team working.

‘Of course you need a structure were people are accountable but the real benefits will become from developing the team and not creating too many hierarchies. I would suggest that the [focus] should be on investing money, time, skills and expertise into developing a team-based approach in those networks,’ he says.

Practices need to form networks by July this year and while some information has been shared by the BMA and NHS England on what these networks should look like, primary care providers might still feel confused about how to proceed, as there are a number of points that have not yet been fully clarified.

According to Dr Patel, the PCH approach to network formation is an established model that has proven successful over the last few years – an expertise the organisation can deploy in guiding primary care, secondary care, and voluntary sector providers through the process of creating one.

Regardless of whether providers chose to go down the PCH route or not it is, however, clear that NHS England considers the network path to be the way forward for primary care.