Primary Care Networks (PCNs) are vehicles for real change in the NHS, aiming to deliver integrated health and care. Dr Neil Modha, a PCN Clinical Director and Clinical Chair of Greater Peterborough Network (a GP federation), explains what his PCN is currently focussed on.
I’m in the lucky position as a new CD, in that I’ve been working on creating more joined-up services in my region for a few years now. That’s given me valuable leadership experience that’s really helped us with getting up and running.
We’ve been working across the population at a higher level for many years in our area – looking at patient populations of up to 1,000,000. These large numbers mean that there is a lot of difference within that patient population in terms of health and levels of deprivation, for example. That is why our STP split itself into two - North and South and I am the Co-chair alongside the hospital Chief Executive of the Northern Provider alliance.
In contrast, our PCN is made up of two practices covering around 40,000 patients. What really excites me about this is that we can develop integrated or joined up care that is focussed on our specific population. This is especially relevant given the deprivation of our population as well as the language challenges. We can look at the challenges they face and the challenges we’re facing looking after them and really thinking about how services need to be different to meet their needs. For example the council have supported us with health trainers who speak a number of different languages who can talk to our patients about smoking, alcohol and weight management.
We have regular meetups with the other practice in our PCN - Central Medical Centre. Our most recent discussions have been focused around workforce issues and opportunities, as well as managing finances.
Some of the key things we’ve been talking about include:
We’ve had some real successes through increasing the number of pharmacists employed by our two practices, but one has now moved on to another PCN closer to home. This highlights the challenge of being an early adopter – other PCNs are coming along and taking the benefit of the work that has been put in. I suppose we should see that as a compliment, but it’s frustrating needing to advertise again to fill the post.
This is complicated in terms of how the various pots are split between the member practices, so we spent time discussing and clarifying this.
We're looking at recruiting first-contact physiotherapists and so we needed to talk about how we'll approach recruitment. We've got a range of options, including employing direct, getting federation support or working with an existing physio provider.
We work in a very deprived environment and a lot of time is being taken up with housing issues – we need to look at how we ensure the council is involved appropriately to make use of our limited resource. Our practice has invited the social prescriber to our practice meeting to talk through the cases she’s been managing. This has spread awareness of what can be achieved for patients. We’ve picked up some tragic cases through this work, such as patients living in shipping containers and some concerning safeguarding issues.
We’re also in the process of putting together a bid to create community champions who will focus on education, health and wellbeing in our challenged population.
The idea is to use experts in primary care, community care and the voluntary sector to help support our patients and the local population. This will focus on areas such as schools, mosques and other religious centres, as well as particular employers.
Another key thing we’re looking at is a regional digital PCN bid – as there is some funding put aside for this agenda. We’re trying to steer this towards delegation down to a PCN level, rather than CCG or STP-wide procurement, as we believe that having bespoke solutions based on the needs of the disparate populations will be better.
Contract negotiations
I think the flexibility with roles is really helpful. For my population, health coaches feel like a no brainer as 40% of my population smoke and I have too many consultations where the patients life expectancy is below retirement age.
Pharmacy technicians are also a great idea as in our practice having a couple of technicians supporting a pharmacist will be a more efficient model. This will help with a lot of the administration related tasks for the pharmacist role, freeing them up to be more patient facing.
Lastly the investment in core GMS is really helpful in two ways - giving 100% reimbursement makes the decision to recruit easier as does increasing the baseline of GMS. We have already had discussions about the £1.50 per head and utilising this more for management resource when the 70% increases to 100%.
But as always the devil will be in the detail and hopefully what is promised will be delivered without too much complexity.
Overall, I feel NHS England has listened to Primary Care Network leaders. The next step would be to gain confidence to trust us that they can invest in GMS - as GPs will utilise this to further improve their practice teams and infrastructure.
It’s still early days, of course, but I think the only way to make progress as a new CD is to focus on a tangible change that you want for your population and try to use this agenda to make a difference and tell a story.
I try to start by asking, ‘What's happening at the moment? What's not working for my population?’ This helps with thinking through what changes to put in place. And then measuring those changes.
Maybe the simplest thing for all PCN Clinical Directors to look at is the workforce that's coming into primary care networks and how it can be used most effectively. The likes of more pharmacists and social prescribers, for example. Thinking through how to make that change have the biggest impact, is a really good place to start.
If we start talking to community providers, mental health providers, the voluntary sector and the hospitals early on, I believe this new resource can go a lot further. So it’s also important to start having those conversations together.
In addition, hopefully there will also be support from higher levels too – such as CCGs and STPs. So make connections with those people and make sure that they know what's on your agenda. Think through how they can help and support you too.