Amidst the craziness of the past few weeks one thing has become more than apparent: we have a significant management capacity problem in general practice at the moment.

The introduction of Primary Care Networks (PCNs) has been a challenge for a number of reasons, but increasingly because there simply is not the management capacity to cope with the workload and expectations that is being put on these fledgling organisations.  The recruitment to the ARRS roles had started to highlight this problem (who is managing, supporting and developing these staff?), but the COVID vaccination challenge has laid this issue bare.

As you are undoubtedly aware, the COVID vaccination enhanced service is only available to practices delivering through a ‘PCN grouping’ (as of 17/12/2020).  Many, many practices have bemoaned this fact, and pointed to the proven ability of individual practices to deliver vaccination programmes, but the clear and unwavering instruction has been that the nature of the vaccine requires this to be delivered at a larger scale.

The work required to put the COVID vaccination service in place has been immense.  There have been estates challenges (fridges!), logistic challenges, patient and process flow design and implementation, call and recall services to put in place, IT and new software implementation, gaining agreement and buy-in from member practices within the group (including agreeing a 30+ page collaborative agreement within a few days), not to mention dealing with the constant barrage of information, requests and demands from above.

But who has this work fallen to?  In some places there are federations with management teams who have been able to support local practices.  Some CCGs have offered staff, but the reality is establishing new services and making them operational within days is not a common skill set amongst CCG staff.  In most cases the work has fallen to practice managers, and often largely upon the practice manager of the nominated ‘lead’ practice.

Now bear in mind that at the same time practices are, like everybody else, in the midst of a pandemic and dealing on a daily basis with staff going off sick or needing to isolate, trying to manage a flu vaccination programme that was opened up to a huge new cohort of patients (50-64s) on 1st December, as well as dealing with all of the other challenges that winter creates.

It is not a surprise, then, that many areas have just had to hold their hands up and say sorry, this just is not possible for us to do right now.  But this surely isn’t the result that any of us, including the centre, would want.

What this situation clearly highlights is that collaborative working and collaborative service delivery, whether in PCNs or PCN groupings, cannot be managed simply as an add-on for practice managers.  It needs its own management resource.  Creating PCN managers who operate in isolation from practice managers is not the answer either.  There is an urgent need for this gap to be filled, in a way that is integrated (not separate from) the existing practice management infrastructure.

The reality is this issue has not been thought through, and has largely been ignored at a national level.  There remains huge national resistance to using any of the ARRS funding for management roles, and very few places have been able to create a management structure that even attempts to integrate practice management and PCN management in a meaningful way.  The COVID vaccination implementation has put this gap under the spotlight.  Maybe this is something the new Institute of General Practice Management can get its teeth into!

The Practice Index Podcast: Episode 5 (Covid vaccination programme) is available now: