- Posted Monday June 17, 2019
As a practice manager with over 15 years of experience, here’s my personal view of the creation of Primary Care Networks and my feelings around how preparations for my own PCN are going.
Primary Care Networks are a key part of the NHS Long Term Plan, with CCGs committing recurrent funding to develop and maintain them and practices given a deadline of June 2019 to get involved. Practices not signing up will find that they lose out financially.
Deadlines are creeping up on us…
The idea is that practices will work together in networks to share resources, knowledge and specialities. All of this can be achieved by either practices amalgamating and becoming one entity, a super partnership, or working under a memorandum of understanding between practices.
This has already started to happen across the country and with deadlines looming, more and more of us will be going down this road as the NHS and CCGs invest large amounts of money in the networks.
In our area we held back on deciding our approach and waited in the hope that we would not have to reinvent the wheel.
Unfortunately this has not the case; it seems everyone is looking at this process and interpreting it differently. Over the last month we have met regularly and have now agreed in principle to work together as a network but remain independent.
How far should collaboration go?
Some practices in the network are talking about us becoming a super partnership within the next five years, whilst others are not so convinced.
In any case, a practice manager and a doctor from each practice have been meeting regularly over the past few years, so we are a team that do already know each other. Our meetings have become more serious and dare I say it a little like Brexit negotiations! There have been plenty of differing views on all sorts of topics and a need to be unanimous on decisions to avoid complications.
I think it is fair to say that we are a little wary of each other and have to build up trust slowly, whilst recognising we are also still a group of individual practices.
We have been lucky in the fact that our LMC has asked to be involved and supported us through this process. They have been offering help and advice in return for them to use the knowledge they gather to pass on for the benefits of others.
The nuts and bolts of an effective Primary Care Network
So where are we now? We have had a meeting with all partners across the practices and have more lined up over the next few weeks. With the money received from the NHS we have been able to backfill for time spent for doctors and practice managers.
We have also have appointed an experienced project manager to work with us over the next few months and take this forward. They are self employed so no issues with Tax or National Insurance. We are waiting for the sign off for our application and will then be in a position to move forward.
At first, we looked at getting accountants and solicitors involved and setting up a managing company but were advised by some of the above not to run before we could walk. We were told to keep it simple.
A practice has been designated to accept all the funds and pay out and distribute as necessary, furnishing the network with monthly accounting figures.
How long this will go on I am not sure, as we may get into difficulties if we decide to employ anyone, as no one practice will want to have the employment responsibilities and the problems that brings. One practice representative has taken the Clinical Role and has done an enormous amount of work.
What do PMs really think about the new system?
So, what are my personal views on this? Unofficially…
I have two main lines of thought, the first being that with recent announcements of an increase in practice closures, it will help to secure the future working within bigger groups - although no one really knows how it will work in the long term.
For that reason, I can see the logic in this, and can support it up to a point, but do have some reservations in the long term.
I cannot though help thinking that this idea has a different agenda behind it. Is it another step on the road to privatisation?
As individual practices we may not be attractive to private buyers, but as super-partnerships covering 40-50,000 patients it does change the dynamics. Suddenly, practices become a far more attractive proposition for large companies to make offers.
Add to that the fact working in groups with people who have been thrown together can lead to disagreements and problems within partnership.
There is a view that practices can share back-room staff and share services - very good in theory but in practice I am not so certain.
What will the effect be on our patients?
We are all different, in my surgery we derive a large amount of income from other outside clinics, and would we be willing to put that in the pot too? I am not so sure.
Will patients be happy losing a sense of belonging and their long-lasting attachment to a smaller practice to going to a bigger, impersonal service? Again, I’m not sure.
Practices that have their own premises will not be happy putting that into the joint pot and the likelihood of a building being built to house several practices is highly unlikely and again would put patients at a disadvantage if they need to travel.
Time will tell how this all works, but my main feeling at this is point is that the theory and the implementation of Primary Care Networks could be two completely different things.