This month marks not only the 72nd birthday of the NHS but also the one-year anniversary of primary care networks (PCNs), which were established last July to stabilise general practice, dissolve the historic divide between primary and community healthcare, and provide a broader range of services for patients closer to their own homes.
This seems a fitting time to assess how well they are performing so far. What have been the key achievements and challenges? What is the picture nationally? And where should PCNs aim to be by this time next year?
To address such questions, the PCN Network, which is part of the NHS Confederation, has this week published a new report ‘PCNs: One year on’. This sets out the concerns that have emerged from our engagement with PCN clinical directors nationally, revealing three key themes.
Firstly, the PCN landscape is currently one of real variability. In some areas impressive progress has been made by PCNs. Our report highlights that there have been successes in expanding digital working, fostering new relationships across primary care and improving services to local populations through the recruitment of social prescribers, physiotherapists and others as part of the Additional Roles Reimbursement Scheme (ARRS).
PCN-working has for many represented a real culture shift. This has been felt most acutely in areas where there has been no strong history of collaboration across primary care or the wider health and care landscape. There remains a significant variability in maturity, with some networks essentially still PCNs in name only. It will be vital to address this variation if the benefits of PCNs are to be felt by all communities across England.
Secondly, the value of PCNs has really been demonstrated through Covid-19. We have heard from many clinical directors that the new relationships formed between practices within their PCN have been hugely beneficial in coordinating their local response to the pandemic. Some have spoken of the PCN acting as a channel through which discussions can take place about the pooling of resources, including PPE. Equally, in areas where progress has been made in facilitating multi-disciplinary working, this has proved to be a real asset as PCNs deal with the management of shielding lists in coordination with the community and voluntary sectors.
Finally, the findings of our report indicate that flexibility and autonomy will be key to ensuring that PCNs fulfil their potential over the coming year. With PCNs due to start delivering new service specifications from this October, a ‘one size fits all’ approach will likely not be effective, considering the huge variation in demography across PCNs. This must be considered as commissioners evaluate PCNs in future. Equally, there needs to be flexibility for clinical directors and their managers to design their network in the way that meets the needs of their local population and to have dedicated management support to help alleviate day-to-day pressures. As the detail of ‘system by default’ emerges at national level, PCNs must also have a central role in the ‘reset’ process locally as services begin to look beyond the Covid-19 emergency response phase.
Overall, the outlook remains positive for PCNs and there is still enthusiasm among many clinical directors that, given the right freedoms and support, they can drive positive change in their communities. The PCN Network stands ready to continue supporting them and their staff as they continue to progress.
If you are working in a PCN then we would encourage you to get involved in the PCN Network. To find out more please visit: www.nhsconfed.org/pcn-network