PCNs and the Money Argument

NHS England recently announced overwhelming take up of new primary care network contract confirming a total investment of £1.4 billion by 23/24 to help deliver an extra 26,000 workforce roles.

Ruth Rankine, director of the NHS Confederation’s PCN Network, said: “This is great news for primary care and for patients. PCNs are absolutely key to delivering the ambitions of the NHS Long Term Plan, ensuring that patients, irrespective of where they live, get access to the same services whilst giving PCNs the flexibility to respond to the needs of their local population.”

So has the development of PCNs now reached the point where the substantial funding and equally substantial expectations are balanced? The introduction of Primary Care Networks in England has been a slow burn – deliberately.    As many of us have discovered lately, being together more than we are used to, can be both rewarding but also challenging. So, it will be the same with PCNs as Practices need to work together to get the best out of the additional resources and to ensure funding and outcome are both equitable and evidenced.

It’s not difficult to envisage some falling out happening between practices. These are difficult times and trying to deliver a single common outcome with member Practices holding differing approaches as to how to get there may be challenging.  Add the transfer of funding and responsibility for providing new services in October this year , including enhanced health in care homes at a PCN level can only add yet another potential source of “healthy discussion”.

Primary care, along with much of the NHS, faces an autumn and winter that is likely to be challenging.  The population’s focus may be on returning to Primark, Next and Greggs now but they also present to their general practices with a backlog of ailments minor and more serious. Against that background, how will the DES deliverables support general practice, align to the long-term plan AND ensure primary care has a part to play in leading and shaping the future?

GPs will be the fulcrum for the next stage of health provision in England with PCNs one of the key vehicles through which that opportunity is being presented.  Making sure resources allocated by the NHS are used appropriately and make a real difference to health outcomes is a key issue.

Those having a leading voice in the development of ICSs will certainly be keen for answers to that question.  The answer of course, lies in having a clear plan around the use of the additional DES funding, the recruitment and deployment of the additional workforce and a different focus on addressing specific local health needs. This latter point needs general practice to go beyond what it has done in the past and look at some of the new ways data is being analysed and used by NHSI and PHE. It’s not a secret but you have to understand how new the future will be to the past.

Key questions are how to demonstrate PCN resources have been used properly and equitably, how accountability is being evidenced for the effective application of these resources and the extent to which population health outcomes are being improved are all really challenging issues. And you have to answer them all, not just one of them.

Most general practices are not used to dealing with these cross-practice implementation issues. Generally speaking, each practice is a self-contained businesses whose financial affairs are very much a matter for themselves.  Working in a PCN, collaborative work to allocate and provide assurance as to the use of monies received is necessary.  Having basic processes in place to receive and account for these monies is part of that work. Like most organisations, PCNs will live or die through the effectiveness of their governance arrangements.  Making decisions around the allocation of resources will be the first challenge and to pass that challenge, PCNs will need to be financially transparent, principled and evidence based .  Getting it right from the get-go is also vital – if trust is lost it will be hard to retrieve.

Primary care services to care homes becoming a PCN responsibility is an interesting development. It must be seen in the context of what has happened and is likely to happen in that sector.  The care home industry was having its issues prior to the recent turmoil.  What the impact will be of Covid and the commercial sustainability of care homes is an uncomfortable question.  Persuading the vulnerable and their relatives that they are safe places to be is now a much more difficult task.  Does that also mean that there will be a significant number of more vulnerable people in the community requiring other forms of social care and healthcare provision?

These are exciting times, mostly in a good way.  Getting it right now sets the foundations for even more exciting times with GPs at the heart of a developing NHS.