Health Policy

No small feat: the challenges of managing Primary Care Networks

By - Primary Care Journal

No small feat: the challenges of managing Primary Care Networks

As Primary Care Networks (PCNs) take a greater role within the NHS, medical and business leaders must focus on practical considerations for organisational structure and development.

The development of PCNs from their nascent state to more established organisations provides an opportune time to discuss how they can be best-financed and managed.

A recent Public Policy Projects webinar chaired by Professor James Kingsland OBE, a GP and former President of the National Association of Primary Care, sparked a positive, pragmatic discussion around the role and future of PCNs. The conversation produced an erudite balance between the exposures that PCNs are likely to face and the solutions that can be employed to reduce these risks.

Mitigating business risks 

Simon Appleyard, Area Manager for Wesleyan Financial Services, the exclusive financial advice provider for the Royal College of General Practitioners, began by reminding the audience that “running a GP practice is a challenge in itself. Adding the complexity of a PCN over the top of that adds to potential business risk. ”

Mr Appleyard explored different factors within PCNs that pose potential business risks to individual partners, such as liability for accidents on shared premises, liability for breaches of non-clinical data, the varying needs between partners at different stages in their lives and careers, and responsibility for covering the cost of staff with long periods of sick leave within the PCN. In particular, he identified the undue pressures that can be placed on lead practices within the lead practice model of PCNs.

Drawing on over twenty years of experience working in financial services, Mr Appleyard had numerous suggestions for how these potentially deleterious factors could be mitigated. In particular, he stressed the need for a proper disputes protocol, especially if there is “resource-hogging” occurring in the PCN. Moreover, he highlighted how collective buying of insurance can save PCNs sizeable costs.

Mr Appleyard also joined the growing call among those working in the primary care sector for PCNs to actively create an identity in order to “help mould an effective business team. ” He noted how using agency staff “doesn't necessarily build that sense of belonging that's important to running an effective team. ” This identity building doesn’t need to be an arduous process, he explained, referencing how Wesleyan helped establish a simple newsletter in a PCN in the North-West which helped contribute to a strong sense of identity among the network’s members.

Workforce professional development: are PCN’s doing enough?

Building on the risks and liabilities outlined by Mr Appleyard was Dr Sarit Ghosh, a General Practitioner and the Named Clinical Director for Enfield Unity PCN, one of the largest networks in the country.

Dr Ghosh outlined four attributes he deemed essential for a PCN’s success: an established corporate structure, robust financial governance, proper indemnity, and workforce professional development.

It was the last of these four attributes that appeared to resonate most with the webinar’s audience, leading to a fertile discussion about how to improve staff retention. Professor Kingsland proposed that the question all PCNs must consider is: “Are we doing enough for workforce professional development? ” 

Dr Ghosh's solution to reduce workforce ‘churn’ was simple: “You need to invest in your staff if you want to keep them. ”  However, he did acknowledge that “economies of scale support progression”, meaning that smaller PCN’s often face the added difficulty of a limited capacity to offer career progression to staff.

Reflecting on this limitation, he added that even smaller PCNs can put training, education and support in place for staff. This echoed a point made by Mr Appleyard that increased pressure from the Covid-19 pandemic on NHS staff necessitates PCN’s having proper wellbeing services in place. Mr Appleyard also forecasted that the need for such services “is going to get into even sharper focus over the next six months as we go through the vaccination period. ”

It was evident from the discussion that financing and managing PCNs is no small feat. It necessitates the mitigation of business risks through proper planning, including a well-conceived organisational structure and thorough insurance policies. 2021 will tell if the NHS is up to the challenge that these complex organisations pose.

This webinar was produced in partnership with Wesleyan.

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