By Primary Care Journal-
While recognising the scope of primary care networks (PCNs) within the current integrated landscape of health and social care, Primary Care Journal (PCJ) hosted a virtual forum to draw out the viewpoint of general practice and its role at the heart of these emerging frameworks.
Professor James Kingsland, a GP and former President of the National Association of Primary Care, sought to explore the developments of PCNs to date, the challenges of the pandemic and what must come next. Dr Karen Kirkham, GP and Senior Clinical Advisor to Primary Care Transformation at NHSE/I, Dr Mark Spencer, a GP, Co-Chair of National Network of PCNs at NHS Confed and Co-Founder of Healthier Fleetwood, a network development in Lancashire, and Dr Farzana Hussain, a Clinical Director of Newham Central PCN, all offered their insights, drawing on experience from the frontline and national level.
“It was just over a year ago that we launched primary care networks,” began Dr Kirkham, reflecting on the process by which 1,200 clinicians were invited to become clinical directors of PCNs. Praising the resilience and strength of primary care in the face of Covid-19, Dr Kirkham continued to outline the extent to which PCNs have been embedded as “key pillars” in primary care services. Throughout the pandemic, GPs have worked together to deliver “hot sites”, she said, developing channels for mutual aid which have benefited the entire system.
“We have seen incredible examples of GPs and primary care networks, not just working together but starting to work a lot more closely with acute trusts, community trusts and the voluntary sector, and this real heart of the community has begun to build,” she explained, specifying three core areas to be prioritised for 2021: management of long-term conditions, population health and workforce.
While PCNs have supported populations during the pandemic, now is the time to review long-term condition management and explore the opportunities presented by digital technology and remote patient monitoring, suggested Dr Kirkham. This approach should also apply to cancer, heart disease, screening and health inequalities, she urged, highlighting greater opportunities presented by collaborating on immunisation and flu vaccinations.
Acknowledging PCNs as a new model of care, Dr Mark Spencer, who calls on 29 years of general practice experience, explained how the model itself has evolved over previous years. “It is not only about general practice,” clarified Dr Spencer, “and it is not only about clinical medicine and managing illness. ” Instead, he outlined how “relationships” between clinicians, anchor organisations in a locality – including schools, local authorities and housing – and the community itself are most important. “When you get those relationships right,” he added, “far more things happen than simply delivering the PCN. ”
With care homes becoming a “second frontline” during the pandemic, Dr Kirkham called for primary care services to collaborate more effectively providing support from clinical leads, multi-professional working and providing care to patients in their own homes. However, there remain obstacles to be overcome. “If we don’t know the data about our own populations, we are in essence flying blind in what we are trying to achieve with our networks,” she added. With support from sustainability and transformation partnerships and integrated care systems in terms of data management, there is an opportunity to profile risk amongst a population to ensure that best care can be delivered. During the pandemic, this has been evidenced by PCNs supporting shielded patients.
In Dr Kirkham’s mind, the “biggest challenge” faced by PCNs are the workforce shortages to be addressed. Welcoming the addition of nursing associates and funding to recruit, Dr Kirkham also expressed concern that six months have been lost due to Covid, resulting in a lack of time to recruit the professionals that are needed. In order to “make real” the values of the NHS People Plan, Dr Kirkham called for investment in general practice and urged the sector to ensure that equality, diversity and inclusion remain high on the priority list.
By effectively “pausing” the management of long-term conditions during the pandemic, NHS England freed up nurses working within general practice to join district nursing teams, supporting the care of people in their own homes. In Fleetwood, explained Dr Spencer, this was not mandated from any authority, but was simply the reflexive agility of key individuals within the network. This form of agile resource management also allowed support for community pharmacy when dealing with the pressures of increased demand. Furthermore, by adapting a model for electronic prescribing which linked all clinicians within the area, dentists in Fleetwood were able to carry out prescriptions.
The PCN is, in Dr Spencer’s view, an “anchor institution” which supports wider healthcare, education and training within a locality. This can be extended further to include “anchor people” in the local authority, education establishments and beyond which allow a more holistic approach to combating the economic, as well as the health, impacts of Covid.
Turning to the challenge of health inequalities, Dr Spencer raised the importance of listening to residents, building on long-term relationships of trust, and empowering communities to think about positive health outcomes. He also called for an expansion to the roles that can be recruited for within a community to better meet local need. In Fleetwood, this means drug and alcohol workers and management support, both of which are needed and yet do not qualify as part of the recruitment drive.
Expanding on this, Dr Farzana Hussain, an experienced GP of 19 years, outlined how primary care services are supporting communities in Newham, her locality. “I was really delighted when primary care networks were born a year ago because, for me, this is about levelling up,” she said. Referencing areas such as Fleetwood which have been progressing in the development of integrated care over the years, Dr Hussain reflected that in Newham Central PCN, which covers 67,000 residents through seven practices, this journey has been a much more recent one. “Getting a relationship with six other practices is not always easy,” said Dr Hussain, but having the Network Contract Direct Enhanced Service (DES) in place has been important in focusing efforts on where the greatest gains can be seen.
With the role of PCNs spanning well beyond GP prescribing services, there is a real opportunity to work with communities, expanded Dr Hussain. Addressing earlier points in the discussion, Dr Hussain echoed the calls of Dr Kirkham for a better framework for managing long-term conditions.
In the context of a second wave of Covid-19, Dr Hussain explained the reassurance provided to smaller practices by the backing of a PCN. With members of her team currently isolating, she remarked that “without primary care networks, my practice would close. ” Instead, PCNs not only provide a lifeline to sustain services, but also have a role to play in mitigating some of the wider impacts of the pandemic. This line of thought considers the NHS as “more than just a healthcare provider”, but an anchor in supporting communities both within and outside in times of exceptional need.
It is clear that PCNs have come an exceptionally long way over the past year and that they are frameworks being utilised to great effect during the pandemic. However, without further support for workforce, long-term condition management and continued exploration into the benefits PCNs can provide in the wider community, the model may not prove sustainable.
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