PCN Network

Government’s health pledges at risk of collapse without proper investment in primary care, warns NHS Confederation

Ruth Rankine

The health commitments made by the government in the general election last month are at risk of being no more than a ‘pipedream’ without greater support and investment in primary care.

In the run up to last month’s general election, the Conservative Party committed to introducing 50 million extra GP appointments, improving NHS performance, increasing access to services away from hospitals, and establishing 6,000 extra primary care professionals, on top of the 20,000 already committed to in the NHS Long Term Plan.

However, the NHS Confederation warns today (Friday 17 January) that these pledges might not materialise because the GPs and other professionals who have been tasked with transforming primary care in their local areas across England have not been given the time, support and funding they need.

The NHS Confederation has talked to and surveyed clinical directors, mainly GPs, that lead primary care networks to find out what they need most to meet the current pressures, transform services and deliver better and more joined up care for patients.

Primary care networks are a core building block to the future of health and the NHS. Not only do they put general practice as the centre of a patient’s care needs but they can allow a much wider range of services to be delivered outside of hospitals, and they can support care to be more joined up in a areas serving populations between 30,000 to 50,000 people. 

The NHS Confederation received 157 responses to its survey. Key findings include:

  • Funding: Nearly half (48 per cent) of primary care networks said they are confused about the funding available to them and how it is allocated. Also, they raised significant concerns about whether the draft ‘service specifications’ from NHS England and NHS Improvement, which will set the requirements of Primary Care Networks for the next four years, are properly funded for what is expected of them. This concern remains even after concessions that are likely to be made by NHS England and NHS Improvement, which the NHS Confederation welcomes. The NHS Confederation is calling for greater transparency on funding and a comprehensive assessment of the cost of delivering the new service specifications.

  • Support: One in two (51 per cent) of clinical directors who responded to the survey said that this is their first leadership role. That is perhaps why almost half (48 per cent) of respondents said without dedicated management support for primary care networks, clinical directors will continue to be overburdened and unable to progress at the pace expected. One clinical director, said: “It is very difficult to do [the] day job of running a practice with PCN work on top … We can’t possibly deliver that sort of workload.” Another said: “I find myself doing PCN work squeezed into an already busy clinical day and in my spare time. I feel unsupported and stressed.” The NHS Confederation is calling for primary care networks to be given protected funding for dedicated management support, alongside ongoing support from their local clinical commissioning groups and integrated care systems.

  • Time: Eight out of ten primary care networks (81 per cent) said they need more time to develop the relationships between their general practices, and with community healthcare providers, that will then enable them to deliver what is being expected of them nationally, including the draft ‘service specifications’. One clinical director, said: “[We] need to build trust and relationships and gain buy-in from a varied group of practices with not very much in common.” Another said: “Time is the biggest problem. The system is moving too fast for grass root GPs.” The NHS Confederation welcomes the signal from NHS England and NHS Improvement that it is likely to amend what will be required from primary care networks in 2020/21 and asks that they are given more time to prepare for the introduction of the remaining service specifications.

These findings come as the NHS Confederation, including NHS Clinical Commissioners launches a new PCN Network, which will provide a collective voice for primary care networks across England and influence national policy and debate, working in partnership the National Association of Primary Care, British Medical Association and Royal College of General Practitioners.

Ruth Rankine, development director for primary care networks at the NHS Confederation, said: “The government has set out ambitious plans for primary care which recognises its vital role in the system, but this vision is at risk of being nothing more than a pipedream because the fundamental building block for this transformation has not been given appropriate time and investment.

“It has been only six months since primary care networks have set up across England and despite the huge potential, there is overwhelming concern that they are far from prepared or resourced to deliver what is being expected of them.

“In particular, clinical directors have told us that they need more time, more support from their local systems, and greater clarity around funding for what is being asked of them.

“We welcome the positive signs from NHS England and NHS Improvement that they are listening to us, and to clinical directors across the country, and urge them to continue this engagement as a priority so that primary care networks can deliver real impact and be a valuable part of the local system. Without action, more clinical directors will walk away and the network model, and the ambition for primary care, faces collapse.” 

On behalf of clinical directors, the NHS Confederation has responded to the public consultation from NHS England and NHS Improvement on the draft ‘service specifications’. The proposals have not been met positively by many clinical directors, with claims that the requirements, such as weekly visits to patients living in care homes, would be impossible to deliver.

Dr Graham Jackson, senior clinical adviser to the NHS Confederation, said: “The future of primary care is as at a crossroads with many clinical directors committed to the opportunity to strengthen general practice and provide new and enhanced services for their patients but they are faced with proposed national requirements for Primary Care Networks that they feel are impossible to deliver in their current form.

“While there are many strong examples across the country of primary care networks flourishing, equally many clinical directors are struggling and are concerned about the sustainability of the model.

“Never has there been a more important time for primary care networks to have a representative body that will speak on their behalf and be an honest broker with the national system.

“We are encouraging clinical directors to register their interest online in our new PCN Network so that they can keep abreast and influence developments on what could be the biggest opportunity for primary care in a decade.”

Primary care networks were set up in July 2019 to transform how primary care is delivered locally. They involve general practices working together and with community health services in areas covering populations of 30,000 to 50,000, to pool their resources and access additional funding that will then allow them to provide new services, such as in community pharmacy, physiotherapy and social prescribing using multidisciplinary teams.

They are led by clinical directors and are seen as a key part of the NHS Long Term Plan; in particular as a response to the rising demand for GP appointments and other patient services, the workforce shortages across primary care, and the need to relieve pressure on hospitals where A&E waiting time standards have not been met since 2015.


Notes to editors

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