Primary care networks (PCNs) are trail-blazing concepts and the great hope for the NHS as it weathers the storms of funding, recruitment and an ageing population living with multiple morbidities.
Blueprinted with the intention of breaking down healthcare barriers and releasing integrated excellence, they face tough conditions as they unfurl their bold theory across general practice.
The perfect PCN will act as a fulcrum of local health delivery, tackle neighbourhood inequalities, lead the way on the prevention of cardiovascular disease and use technology to link up services for co-ordinated care.
But it is facing a GP profession short on numbers and confidence, a huge range of demographics, from inner city to rural, and patient concerns that their health records and data remain safe as they bounce round a network of GPs, healthcare professionals and community carers. All this against the clock and a rising tide of an ageing population, and with IT systems that can struggle with interoperability.
Strong collaboration boosting success
Almost a year in and the assessment of primary care networks is “promising, but has some way to go”.
Ruth Rankine, PCN director for the NHS Confederation, says: “The progress is variable. At one end, those that had been operating as primary care homes and had good relationships with local providers are ahead of the game. But, at the other end, there are those with fairly significant challenges.”
It is a view echoed by Dr Richard Vautrey, chair of the British Medical Association (BMA), who adds: “It is early days, but in areas where there has been a history of collaboration and alignment, they are doing well. But it is taking a bit longer when they are building from scratch.”
The BMA and NHS England/NHS Improvement recently negotiated extra funding for administrative staff to ensure the back-office delivery and healthcare support staff, but there is a huge responsibility on individuals to collaborate across care homes, mental health services and the real-time sharing of health records.
Some areas are doing well. But it is taking a bit longer when they are building from scratch
“I have the sense that now the GP contract has been agreed, people are getting on with it and they are thinking innovatively about how they can utilise the different roles,” says Rankine. “In most cases, they are getting strong support from their clinical commissioning groups and grabbing the opportunities. Some primary care networks know what they want to do, but need some support to get there.”
Patient records are logged on two main systems, EMISS and SystmOne, which can synchronise, but interoperability varies, she says, adding: “There are pockets of the country where primary, acute, community and mental health are all joined up. Others still have some distance to travel.”
Learning from common PCN challenges
But the focus of PCNs should be about creating more integrated patient care pathways then deploying technology in support, says Rankine. An example of this potential is highlighted in a WhatsApp group of clinical directors who are sharing best practice emerging from primary care networks around the country.
“A lot of really good stuff is happening out there, so it is about gathering that in an intelligent, dynamic way and sharing it,” she says. “Each PCN will be different but, across geography and demographics, there will be common challenges which we can learn from.”
Vautrey, a GP in Leeds where there is an advanced care record system, says: “We would hope to see a much greater emphasis on interoperability across the NHS so we will see greater opportunities for sharing information without the need for everyone to be on the same clinical system. We need to have a common record so care plans can be shared and we do things once rather than two or three times over.
“These are teething problems. It will take time and there will be challenges. The emphasis must be on developing the workforce and building the teams, rather than try to do what the NHS has historically tried to do, to micro-manage and create excessive targets, which is not helpful.”
Data safety and cyberthreats are still concerns, but NHS Digital believes its security is strong enough to allay patient fears and resist attacks.
Primary care networks are seen as a vital step forward, but the Health Foundation cautions: “PCNs require practices to move beyond their traditional boundaries. Sharing financial resources can both generate and strain relationships, and practices will have to trust each other if sharing both staff and data is to benefit patients. The challenge of implementing PCNs must not be underestimated.
What are PCNs?
A key part of the NHS Long Term Plan, primary care networks were created in July 2019 to create a geographically formed network of general practices, covering 30,000 to 50,000 patients. They will give more formal structures to collaboration between GPs, pharmacists, district nurses, mental health services, acute trusts, social care and the voluntary sector, in an effort to provide better personalised and preventative care for their local community.
The idea is that they are small enough to provide the personal care valued by both patients and GPs, but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care systems, according to NHS England.