Primary care networks (PCNs) can free up capacity and foster ‘collaboration and innovation’ if they recruit the ‘right’ professionals via the additional roles scheme, a PCN manager has said.
Speaking at the Management in Practice virtual festival (23 October), Tracy Dell, lead manager at North Halifax PCN, said networks needed to recruit with the needs of the community in mind.
She added that the availability of new additional roles present ‘more opportunities than challenges’ and that with a fitting multidisciplinary team, networks can offer more specialty services locally and deal with a variety of patient needs in a single visit.
The Additional Roles Reimbursement Scheme initially entitled PCNs to access funding to support recruitment across five reimbursable roles – clinical pharmacists, social prescribing link workers, physician associates, physiotherapists and paramedics – with six new roles added in April 2020.
In August, NHS England warned PCNs that they may lose any funding they do not spend on recruiting from those roles this year.
Ms Dell shared advice and some lessons her PCN has learned in expanding the workforce.
Deciding which areas need recruitment
Ms Dell said there are five PCNs in her area, which each have between 40,000-50,000 patients, and that her network is unique in that it is run independently, while the others are managed by the GP federation.
‘The size, makeup and arrangement of your PCN is important and relevant to everything you do as a PCN,’ including recruiting additional roles, she explained.
‘Make sure that you’re selecting those roles on the basis of evidence that you’ve gained. For example, we have quite a high disease prevalence and issues around mental health and substance misuse,’ she said.
‘We have a high number of non-English speaking patients registered in our practices, and we also deliver, through one practice, the Syrian Resettlement Programme.’
She added: ‘It is really important to get an understanding of all that to be able to direct and guide the services that you deliver at PCN level.’
Not just the obvious roles
Ms Dell said that some PCNs have adopted similar roles to each other – a trend that she believes could lead to missed opportunities.
‘We can all play it safe and go with a pharmacist and the pharmacist technicians and some of the other clinical roles that we’re familiar with, but often we miss massive opportunities by not looking outside of that to the social prescribing workers, the occupational therapist and some of the unfamiliar roles,’ she said.
PCNs could ensure they see the benefits of recruitment by ‘working in partnership, doing the research and establishing what [those specific workers] actually deliver,’ she added. Doing this jointly with other agencies that are more familiar with these roles can help to make this a success, she said.
Ms Dell believes it is important to think outside of the Direct Enhanced Service (DES) contract – her PCN has recruited certain roles outside of the network funding, including a phlebotomist and a home visitor.
‘There are other opportunities that you can explore through additional funding from different sources. We’re looking at the support for staffing for our PCN, including management, HR and finance, and we’re also starting to explore some issues around support for IT and data analysis as well,’ she said.
As part of a longer-term plan, the North Halifax PCN is also considering appointing a clinical and financial lead, as well as management roles, which either means finding additional support or ‘working more collaboratively with practice and business managers’ across the five practices, Ms Dell said.
This may also need some further administrative support for minute taking and appointment configuration, which may mean creating an apprentice or junior role.
Ms Dell said her PCN directly employs most individuals via the lead practice and under its terms and conditions – which the individual practice have agreed collectively – and that aligning these employment conditions has been ‘quite a positive exercise’.
‘I know it can be difficult for practices to open up about how they employ and recruit staff within their own practices because it does become quite competitive,’ she said.
‘But if we can get over that competitive edge, and stop worrying about that fear of stealing each other’s practice staff, we can start to think very collectively as a PCN.’
Ms Dell concluded by explaining that her PCN has had to learn from previous mistakes made in managing newly recruited staff.
‘We got it wrong the first time we recruited clinical pharmacists, because we set those pharmacists up in individual practices, and isolated them quite accidentally,’ she explained.
‘They would work in a practice, often in a room where nobody really knew who they were, and log into the system and just get their work done.’
Despite efforts to integrate the team into the PCN, two pharmacists ‘resigned on the basis of not feeling included or the role not being quite what they expected it to be’, Ms Dell added.
The PCN then ‘took a step back’ to look at the issue, and decided to have the team set up in a single large room at one of the practices to work ‘closely together’, while also socially distanced.
‘That gives them that belonging, and feeling that they integrate within that team,’ she said.