Health Policy July 16, 2019
Why Primary Care Networks sit at the heart of the NHS Long Term Plan

By Daniel Male - Accountable Care Journal

On 1 July, over 1,200 Primary Care Networks (PCNs) came into being across England. Many of these networks were already up and running and delivering improved outcomes for patients in their area. However, others are still finding their feet and assessing how best to use the resources at hand to improve care and deliver on the aims of the NHS Long Term Plan.

While the addition of ‘PCN’ to the growing list of confusing health acronyms may cause some to roll their eyes in exasperation. In this case, that would be a mistake. Due to the manageable size of patient/population cohorts that PCNs seek to serve – a flexible 30,000-50,000 range to account for geographic and demographic variation – leadership is able to be dynamic enough to have impact, while operating at sufficient scale to allow for larger schemes to be successfully implemented.

The trailblazing Primary Care Home model, pioneered by Dr Nav Chana and Professor James Kingsland at the NAPC, demonstrated the importance of strong leadership and ‘building system-wide relationships’ in order to improve population health. PCNs will take the learnings from here and package them up in a national framework allowing them to benefit from the Royal College of GPs ‘six enablers’ as outlined in their Vision for General Practice: Funding, workforce, modernised GP premises, training and education, digital technology and research and innovation.

Integration, prevention and digital

The NHS Long Term Plan, which set the direction for health and care delivery in England for the decade ahead, placed an emphasis on three key areas; integration, prevention and digital. Each of these is likely to be a top consideration for the newly assigned PCN Clinical Directors – the formal leads for every network. While the practical size of PCNs enables these policy focuses to be impactable within visible timeframes, the supporting framework at the national level gives them credibility and the necessary support to act on the directives.

Integrating services starts with workforce. GPs will recruit multi-disciplinary teams, including pharmacists, physiotherapists, paramedics, physician associates and social prescribing support workers to support PCNs, freeing up family doctors to focus on the sickest patients. These will sit alongside newly created Integrated Care Systems which link primary care providers to acute sector trusts and community services. Going further, PCNs have the opportunity to engage further with local government to ensure the specific needs of communities are met.

Simon Stevens, Chief Executive of NHS England and Improvement, called the new way of working one that will “keep all that’s best about British general practice, while future-proofing it for the decade ahead,” adding that, as PCNs get up and running, “patients will begin to see the benefits, freeing up GPs to focus on the sickest. ”

This endorsement has been supported by funding for primary medical and community care which has seen increases as a share of the NHS budget for the first time in the health services’ 71-year history. An extra £4.5 billion a year is to be invested in primary care by 2023. It is expected that this boost will further empower GPs ability to identify, intervene and prevent illness before it develops.

Through PCNs, GP practices will be able to drive further action detecting and preventing conditions such as cancer and heart disease, as well as doing more to tackle obesity, diabetes and mental ill health, and support older people at home and in care homes. In the case of Healthier South Wirral PCN, for example, Age UK worked in partnership with the PCN to appoint Personal Independence Care workers as part of a frailty pilot aimed at helping people in their own homes. In this locality, the network has reduced the need for GP appointments among those getting proactive support by more than half, and experienced a 25 per cent reduction in unplanned hospital admissions.

With Leadership from the Department for Health and Social Care and support from bodies such as NHSX and NHS Digital, PCNs can open the ‘digital front door’ to new innovations. The conditions are now in place for technology such as video consultations and digital appointments to be adopted across primary care services. Of course, for this to be impactful, effective data sharing processes need to be implemented. The Long Term Plan set an ambitious vision and, even in their earliest days, PCNs look to be instrumental in seeing it to reality.

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