The Fuller Report published earlier this year signalled that Primary Care Networks (PCNs) should ‘evolve’ into Integrated Neighbourhood Teams (INTs). This evolution is to happen quickly, aiming ‘to move to universal coverage (of INTs) throughout 2023 and by 2024 at the latest’.
What should PCNs and general practice be doing now to prepare for this change? Here are four actions to consider.
1. Identify a local focal point for building relationships
While it is important to build relationships within an Integrated Care System (ICS), the starting point for general practice and PCNs is to consider who will build these relationships and how they will do it.
All too often PCN relationships with community trusts, mental health trusts or social care break down because the local team is unresponsive or too busy. The problem is there is no place or mechanism of escalation. The starting point is to build relationships between organisations at a senior level (ideally Chief Executive, but certainly director level), to align direction and purpose but also to operate as a point of escalation when problems inevitably occur at individual team/PCN/INT level.
Of course, this works both ways. For general practice this requires them to identify one or two individuals who will be the focal point for relationship building at the system level. They need to be the person who general practice trusts enough to escalate their issues to, but who they are also prepared to listen to when issues come the other way. Relationships are not, after all, a one-way street.
By ‘system level’ I really mean someone at the level of the local place area. While ideally it would be at ICS level the problem is that these areas are so big that any one individual is unlikely to even know all the practices and PCNs, let alone have positive relationship with them all.
Identifying someone to be the person who can take this on is difficult. Funding for this (if there is any) is likely to come from the system, but the person has to be chosen by general practice for it to work. While it would ideally be a GP it is rare for GPs to be able to invest the time in personal relationships needed for this to work, so it may have to be a combination of a lead senior manager for general practice working alongside a clinical lead.
This is a critical step. Without this, relationship building at individual PCN level is almost doomed to fail, because when things get difficult (which they inevitably will) there is nowhere to go. Making sure this focal point for relationship building on behalf of general practice is in place at a system level will be crucial for making the transition from PCN to INT work for general practice.
2. Establish who will coordinate the support for PCNs/INTs
The Fuller report is clear that support for the new INTs (HR, quality improvement, organisational development, data and analytics, finance etc) will need to come from ‘larger providers such as GP federations, supra-PCNs, NHS trusts’ and not from within PCNs themselves.
Whoever takes on the role of providing this support will become hugely important for general practice. As more and more of the funding is channelled through INTs it is highly likely this type of support will also be provided to practices in future.
The risk for general practice is that if it has no vehicle for providing (or at least coordinating) this support, then it will default to being provided by alternative provider organisations. This in turn means much of general practice funding will come to practices via these organisations. For areas who are keen to preserve the independence of local general practice making sure there is an in-house option should be a priority for now.
3. Review the PCN configuration
While I can almost hear the groans as you read this, the configuration of PCNs needs to be considered specifically in relation to how community, mental health and social care teams are organised. If these already naturally align then great, no action is required. But if there is a disconnect between the two then this will need to be addressed.
It may mean that two PCNs need to start working more closely together, for example if they are two halves of how the community teams organise themselves. It may mean a full rethink of the configuration of PCNs is required. The important piece at this point is for general practice to consider what a sensible solution and way forward is. It is inevitable the question will come up, and much better for general practice to be prepared with what they think the answer should be rather than simply waiting to have a solution forced on them by the system.
4. Consider potential INT priorities
The vision for INTs is to bring together previously siloed teams and professionals to do things differently to improve patient care for whole populations. Inevitably this will begin by focussing on specific areas or problems. The system will have its own ideas on what these initial priority areas should be, but if INTs are to be genuinely bottom-up entities focussing on specific local needs (as opposed, for example, to ones meeting national DES requirements) then PCNs should consider what they want the initial priorities to be.
A good starting point for this is to focus on the common problems practices are experiencing. The system is good at starting with the problems secondary care is experiencing and trying to build collective priorities around these, but is generally less good at starting with the problems general practice (and to be fair other local providers) are experiencing and working from there. Areas such as workload, recruitment, estates are all potential initial INT priorities. Being clear upfront on what PCNs and practices want these priorities to be means there is a much greater chance of this ending up being the case. But in the absence of any local steer the system will undoubtedly provide one.
Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs.
