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PCNs need to appoint more managers to be sustainable, says report


By Awil Mohamoud
Reporter
12 November 2020

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Primary care networks (PCNs) must increase their management capacity by drawing on further support from GP practices and colleagues to ‘meet the challenges ahead’, according to a report from the National Institute for Health Research (NIHR).

Analysing how PCNs have fared in their first year, researchers concluded there has been ‘good progress’ in establishing the new organisations, recruiting staff and readying new services.

The study, which followed four PCNs in their journey, also found networks had faced challenges around sufficient management support, excessive workload, and the risk of burnout.

It highlighted that some staff, but mainly clinical directors and practice managers, were having to carry out much of the network development tasks on top of their usual ‘day job’. 

This includes the time required for meetings, staff recruitment, implementing new roles and services alongside core services and admin, it added.

The report said: ‘PCNs need to build further leadership and management capacity from across wider primary care teams in order to assure their longer term sustainability, being careful not to rely too heavily on their GP clinical director.’ 

The researchers said clinical directors are ‘often over-extended and do not always have the appropriate mix of non-clinical skills and capacity needed to successfully lead a network’. They recommended a greater degree of ‘professional managerial roles and support’ within PCNs to help overcome this. 

‘There may be local staff within practices and the broader primary care and community health sector (e.g. practice managers, nurses, pharmacists, voluntary sector managers) who would welcome the career development opportunity to become more involved in managing primary care network activity,’ the report said. 

‘An operational success’

The report concluded that it was ‘too early’ to determine the overall impact of PCNs, but said  early evidence points to an ‘operational success in setting up managerial structures, hiring for new roles, and providing integrated services’.

However, some involved in the study said the amount of time and work involved in setting up and running a PCN ‘had led to frustration, disappointment, and even talk of leaving the network’ – against their initial expectation that PCNs would alleviate those burdens.  

The report urged the Government to give PCNs more freedom, stating there is a ‘paradox’ in that they are expected to meet local population health needs, and yet also face ‘nationally-specified requirements to employ certain professionals and introduce defined services’.

This has posed a particular challenge in rural areas ‘where it is sometimes perceived that PCN policy does not align easily with local capabilities and needs’, it added.

‘Taking time to clarify the role of PCNs within the health and social care system may help clarify how they work in relation to their local clinical commissioning groups (CCGs), and their role in delivering on both local and national priorities,’ the report said.

The researchers also called for NHS England and Improvement to provide ‘further clarification’ over what role PCNs will play in the wider health and social care system, especially in the context of the Covid-19 pandemic and its aftermath.

‘Made good progress’

Professor Judith Smith, lead author of the report, said: ‘Our research revealed that primary care networks have made good progress in their first year, establishing their new organisation, recruiting staff, and preparing plans for more services in future years, including those that can enable more rapid diagnosis of cancer, and provide enhanced support for people living in care homes. 

‘They have however faced significant challenges, including playing a key role in the local primary care response to the Covid-19 pandemic. On a practical level, they have had to work out how to ensure sufficient management support and address some tensions between national and local priorities for goals and direction of the networks, together with concerns about excessive workload.’

Sarah Parkinson, report co-author, added: ‘We were able to speak to leaders of primary care networks from across the country about responses to Covid-19, which revealed that these networks were one of the mechanisms through which primary care responded to the pandemic. 

‘Primary care networks helped organise important measures such as ‘hot’ and ‘cold’ hubs for general practice care, remote working solutions, and centralised systems to triage patients to the most appropriate service. 

‘Moving forward, it will be important for primary care networks to explore what pandemic-focused services should be maintained longer term, and how Covid-19 has shaped the development of networks.’

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