The ultimate aim is that PCNs will bring new benefits to patients by becoming more person-centric and bringing care services closer to home.
PCNs are central to the provision of integrated, at-scale primary care. They will work closely with acute, community and mental health trusts, pharmacy, voluntary and local authority services, encompassing services beyond core general practice.
“The main aim of PCNs is to focus services around local communities and help rebuild and reconnect the primary healthcare team across the area they cover through the network, providing workload support for practices at the same time. LMCs and CCGs will work together to ensure practices will lead and direct these networks, it will help GPs and primary care practitioners to deliver a new model of care for their patients and communities.” BMA
So, where to start?
Structure, governance and decision making
Developing a structure with the necessary levels of commitment and expected deliverables are the first steps. The organisational structure that practices choose to go with will need to be robust with appropriate governance structures in place. Clear lines of accountability need to be agreed. As well as considering how PCNs will interact with other primary and community care organisations, agreement on data sharing, dispute resolution, finances and HR policies all need to be in place.
How the network’s clinical director is selected is entirely at the discretion of the network. Practices may wish to select a clinical director based on a normal appointment process, as they would for any other role within a practice or practices may wish to select the clinical director by election.
Federations offer the same type of support as the CCG in terms of allocated resource and provide funding for it. This is a much better fit as it fulfills the desired bottom-up approach. However, Federations can tend to be a somewhat myopic and either miss this opportunity or often don’t have access to the resources they need.
Appointing the right people within the PCN structure is vitally important. They should be forward-thinking and transformational. This may be a challenge as the people expected to do this already have a core role within general practice and are not notorious for an avant-garde approach.
Once the structure is in place, developing the PCN’s priorities is the next challenging issue, requiring engagement across the CCG and other providers. The decisions around priorities should be a bottom-up approach but there is the danger of top-down coercion from CCGs. This needs to be managed to ensure the right commitments and deliverables are in place from the outset.
Initially the focus will be on team development to deliver the provision of workload support by taking responsibility for some services of the member practices, as agreed by the network, focusing on extended-hours delivery in the first instance. The network may decide to restructure some service delivery and extend the workforce. Networks will be expected to begin recruitment of a pharmacist and social prescriber in the first year, as it starts to develop an extended primary care workforce. Staff already working within the network will need to be upskilled as they take on more responsibilities.
As the PCNs become more established, PCN-specific services can be introduced. The DES will provide a menu of options to enable PCNs to discuss and agree which services the network should provide to best fit the needs of its member practices and local patient population. Eventually, the PCN will become an established forum for shared-learning and quality improvement. Regular meetings of its membership will take place, using relevant legal and HR advice on maintenance and day-to-day running. Premises and infrastructure will need to be regularly reviewed to ensure best use of space and facilities.
All set to go?
As mentioned earlier, the ultimate aim is that PCNs will bring new benefits to patients by becoming more person-centric and bringing care services closer to home. There is much to be done to achieve this but there are also many support mechanisms available to help. The PMA Consultancy is one option.