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PCNs – positive impact on practice staffing or untapped potential?

Before Covid-19 reared its very ugly head and turned the world of general practice upside down, Primary Care Networks (PCNs) perhaps held the title of biggest disruptor.

That was partly because PCNs, from 1 July 2019 – were expected to cover all patients in England, regardless of whether their practice was part of one. It was also partly because they had significant potential to the staffing makeup of GP practices by adding a series of additional roles to the existing workforce.

Formalised in the 2019/20 GP contract, NHS England promised 22,000 additional clinical staff by 2023/24 that would be employed through primary care networks. The first network-based roles funded by NHS England were social prescribing link workers and pharmacists.

Now that the dust has settled, how have these roles been adopted by practices? Some light is shed by a recently published survey from healthcare publisher Cogora called The State of Primary Care 2019, which can be accessed here.

While the situation has changed considerably since the survey was conducted, key findings from the report include:

Social prescribing link workers

  • 62% of practices had access to a social prescriber, either directly through their practice or through their network.
  • The target of having 1,000 of these workers supporting PCNs by April 2021 was missed.
  • Of the respondents who do not currently work with one, 39% either wouldn’t employ one or were undecided.

Pharmacists

  • Nearly half (48%) of GP partners and practice managers reported that they did employ one – the same proportion as last year.
  • The number who said they didn’t currently have a pharmacist in their team but would consider employing one has dropped significantly – 23% in 2019 compared with 39% in 2018.
  • 22% of respondents said their PCN employed a pharmacist.
  • Just 4% of this year’s respondents reported that they neither currently employed a pharmacist nor had plans to do so, compared with 8% last year and 14% in 2017.
  • Again, this falls significantly short of expectations – it is hoped there will be 7,000 working in practice networks by 2023/24.

The survey notes that networks were initially given 70% of the funding to employ pharmacists by NHS England. However, following concerns that its contribution was insufficient to allow PCNs to attract suitably qualified pharmacists, NHS England announced in February that it would fund all 12 clinical and non-clinical roles in full, from April this year.

Physician Associate (PAs)

  • More than a quarter (27%) of GP partners and practice managers said they employed a PA, up from just 7% last year.
  • Meanwhile, 12% said they employed one through their PCN.
  • Furthermore, 29% said they would hire a physician associate despite not currently doing so – suggesting that more practices are beginning to see the advantages of having this clinical role in the skill mix.

Mental health practitioners (MHP)

  • The number of MHPs working in general practice has almost tripled in the past year.
  • 27% of GP partners and practice managers have recruited a mental health therapist to their practice.
  • In addition, 17% of respondents to this year’s poll said they wouldn’t employ a mental health therapist because their PCN already did so.

Physiotherapists and paramedics

  • The majority of respondents who don’t currently work with physiotherapists or paramedics said they would employ one (69% and 60% respectively).

Communication needs to change

Overall, the survey highlights how there’s plenty of untapped potential (and unspent budget too, you could assume), so why aren’t more practices utilising staff in the new roles?

“For me, it’s about communication,” one PM told us. “Before coronavirus, of course, I think the various powers at be could and should have worked harder to tell us all more about these roles. I appreciate that information is out there, but it’s easy to miss in the maelstrom of practice life – the old mantra that you need to see something three times before responding rings true here. It’s one thing if you’re actively looking for information, but often as practice managers we’re not!

“My partners are reluctant to try anything new at the best of times, so I feel more should have been done to tell us about the benefits. For example, while not related to what we’re doing with our PCN, we’ve been discussing what a nursing associate does and how do they differ from an advanced nurse practitioner? What value do they bring? I’ve since been told that a nursing associate is an HCA who has done an extra course, whereas an ANP is a qualified RGN with a significant amount of years under their belt and who now works as an independent prescriber and sees their own patient list. That’s the sort of concise information we need, not reams and reams of long-winded publications.”

Further reading: Details regarding the Additional Roles Reimbursement Scheme roles and their Job Descriptions can be found here.

Time to challenge thinking

“I think it’s also fair to say that certain members of staff feel threatened by the ‘new’ roles. And that probably stems from lack of knowledge too. Our nurses, in particular, really pushed back against the idea and that’s ultimately why we didn’t go ahead. That’s not to say we won’t in the future though.”

The flip side of this argument was put forward by another practice manager, who said that it’s time practices challenged existing roles: “It’s fair to say that some members of staff – especially practice managers – welcome these new roles as they can see that having a multi-disciplined team will reduce the workload burden. Quite often staff in primary care are too inward looking and have been unchallenged for many years… “we do it this way at this practice”. I find this infuriating!”

Another PM suggested that a central recruitment hub would be useful. “We discussed at length the possibility of hiring a physician associate, and we even advertised for one, but struggled to get any applications at all. Maybe this already exists, but if there was a central database of newly qualified candidates, or list of people available to fill the various roles, I’m sure we would have taken the idea further.

“Looking forward, there’s a danger we’ll lose some of our staff to the stresses and strains of coronavirus – those already wavering and thinking about moving on may be pushed over the edge – so these new members of staff could be priceless. Mental health may also be a wider community issue, so these new PCN roles will probably come into their own. From this perspective they’re certainly a positive.”

Only time will tell what impact coronavirus will have on GP practice staffing, but it does look highly likely that the ‘new’ roles created as part of the PCN rollout will continue to become more commonplace. That just leaves the issue of practice manager workload (and funding, of course) allied to PCNs – but that’s a topic for another day!

Practice Index PCN PLUS members can access a wealth of resources covering PCN recruitment, including funding, job description templates and information leaflets. Click here to access

 

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