The readily awaited Primary Care Network Development Prospectus was released recently (August 2019) and clearly sets the tone, expectations and windows for achievement for networks in the coming years.
The prospectus articulates the process and need for support based on two critical areas: Primary Care Network (PCN) development and Clinical Director (CD) development.
“Supporting the development of Primary Care Network Clinical Directors so that they can create thriving Primary Care Networks is a significant priority”
PCNs (and CDs) are starting to get to grips with their roles and responsibilities and everyone wants a piece of their limited time but there remains a need for formal development as individuals, networks, groups of individuals and groups of networks.
“Clinical Directors will need to be skilled in fostering goodwill and co-operation to achieve the Primary Care Networks objectives”
We are seeing a large number of CD positions being headed by non-traditional practitioners who are keen to understand and explore some of the elements that have been underutilised in primary care and general practice historically, such as population health management and workforce reconfiguration to deliver their PCNs desired outcomes.
We are working with and alongside a number of PCNs and systems across England, and are experiencing first-hand, the challenges and uncertainty they are facing.
For many PCNs and CDs, the immediate need is to really understand their population and what they need – with an initial focus being on how PCNs can work together successfully across an STP or ICS footprint where there are clear and parallel outcomes. Business planning is the forefront theme we have encountered, with many networks wanting to resolve this before doing anything around new roles (funded or otherwise) or commencing with service improvement projects.
The prospectus places pressure on these networks with the expectation that business planning will have been done, work started on improving services, and that 100% of funding entitlements for year one will have been made use of by March 2020 and be ready to deliver the new service specifications from April 2020. No mean feat with half the year effectively gone already.
Based on our experience, there are three key areas that the existing workforce want to focus on: Sustainability, Workforce and Investment.
These will be familiar to all who are working in and around general practice and haven’t changed in recent years and are also considerably interdependent.
Many networks are struggling with the “how” in terms of what they need to become sustainable as practices and networks. The key questions we are helping PCNs and systems to understand, work through and deliver on are:
- Are we ready?
- What needs to come first?
- How can this be achieved, what are the steps involved?
- What are the challenges or barriers to achieving this?
- How “different or novel” can we be?
What areas should Primary Care Networks and Clinical Directors be aware of?
There are a number of areas that PCNs and CDs needs to be mindful of in their beginnings.
- With the release of the revised maturity matrix networks needs to be honest about where they are in their development and not underestimate the scale of the challenge in achieving maturity.
- Networks need to have a good working understanding of the system they work within, not just their network but the CCG and wider STP/ICS system and what else is happening in other parts of the system that could compliment or challenge their aspiration.
- Networks and CDs need to employ a formal methodology of understanding their population, accepting the outcomes and develop a delivery plan that focuses on specific needs – and start delivering on it.
- Change management is challenging, handling and manoeuvring in the cultural change and delivery shift requires clear messages and direction for all system members and to truly achieve success, requires ALL staff to own the changes and be enthusiastic for them, understanding the opportunities the changes affords both the patients and them as individuals and employees.
- Business plans need to be created that document the aspiration, what success looks like and how is proposed to be achieved, but this should not be to the detriment of delivery.
- Workforce challenges need new novel approaches – understanding your goals and desired outcomes will inform what workforce you need and how it should be configured. Leveraging networks pooled resources can achieve this when approached in new ways or working.