When we discuss networking, we’re often talking about networking as individuals, building relationships and sharing experiences, expertise and contacts. So what approach is being taken towards Primary Care Networks (PCNs), and how are you going to ensure your network’s going to succeed?
The approach should be very similar. If it’s going to succeed, member practices should have been building relationships from the outset, particularly if they’re new to one another. Let’s not forget, there are going to be between 30,000 – 50,000 patients per PCN. That’s a lot of staff and a lot of practices working together – the latter being the key to success.
There may have been some hurdles to overcome at this early stage; maybe your senior GP has never got on with the senior GP of a neighbouring practice? It’s time to make amends and focus on the future, as one of the initial steps is to appoint a Clinical Director. The CD can be elected or appointed and it’s up to member practices to do so. Whichever process is chosen, it must be conducted in an open and transparent manner. Now, what about funding? That is, funding for the clinical director role. Will the incumbent be remunerated directly, or will it go to the practice to fund cover for the CD when they’re away from the practice on PCN business? Lots to consider.
Maybe I’ve gone a step too far… Let me rewind ever so slightly and raise the subject of governance (please don’t stop reading at the thought of governance). There will need to be established robust governance arrangements in place before service delivery commences. Good governance will underpin the effectiveness and success of the PCN. That includes management and administrative support mechanisms, which should see regular meetings held (and minuted) from the initial formation to when service delivery commences and beyond.
When referring to governance, it’s important to consider decision-making and this covers a number of key subjects:
- What is the overall decision-making process?
- How can decisions be reached – majority or unanimous, for example?
- What is the structure of each meeting? Who is the chairperson?
- What is the role of the CD and what is their remit in terms of decision-making?
- What happens when an agreement cannot be reached? What is the process for resolve?
- What is the financial management process for the PCN?
- Who approves policies and procedures? Are they PCN-wide policies and protocols or are they individual practice policies and protocols?
- How do you involve other agencies and organisations? What is their remit and is this by means of a formal or informal agreement?
Part of this process will have involved determining the structure of your network. There are many structures to consider too – for example, flat practice network, lead provider, GP federation / provider entity, super-practice and non-GP provider, to name but a few. All of the aforementioned have benefits and risks, which must be considered at the early stages before the PCN decides collectively on the chosen structure.
A lot to consider and we haven’t covered service delivery yet; how will this change for your patients? What have you discussed so far? What elements of general practice are you going to restructure? The latter is a decision for the network as a whole. I should reiterate that change will be a continuous theme during the early phase of delivery. Service delivery will be enhanced; there will be additional team members – where will they work from, will premises need to be restructured?
While on the subject of the future, it’s perhaps apt to state that PCNs will have access to what has been called “investment and access” which will be available from 2020 and is for the development of community-based services, the overall aim of which is to reduce attendances at the emergency department, for example. Funding levels start at £75m and will rise to £300m over four years.
So, what’s next? Well, on 15th May 2019, PCNs must have submitted their registration form. The next key date is 1st July 2019 which is the go-live date for PCNs. Another change in direction for general practice! Surely it won’t be the last. But for now, the focus must be on establishing the foundations of your network and progressing towards the go-live date of 1st July 2019 – that’s five and a half weeks from now!