NHS's local level changes: after restructuring comes reconfiguration and a new acronym - the PCNUnder the recently announced NHS Long Term Plan (published 7 January 2019), GP practices are to be arranged into Primary Care Networks (PCNs). Practices do not have to join a PCN, but they will forgo extra money if they do not do so.
Each Network is will be designed to serve 30-50,000 patients - with rural groupings at the lower end of those numbers. The Wiltshire Clinical Commissioning Group (WCCG) have been working on plans for the county's PCNs with staff from McKinsey - the giant international American-based management consultant company.
They have come up with a scheme for eleven PCNs across the county. The aim is to get GPs and community health services working together with social and mental health services 'to provide genuine proactive integrated care'.
Through your local PCN, improvements coming to a surgery near you - sooner or later - should be first contact physiotherapy, extended access (i.e. GP appointments available on more days and at more times of day), and social prescribing (e.g. paying for a patient's access to a gym or a walking club).
Each PCN will have seven national service 'specifications' - that probably means 'added services'. Five will start in April 2020: "...structured medication reviews, enhanced health care in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis." Starting by 2021 will be "cardiovascular disease case-finding and locally agreed action to tackle inequalities".
In 2019-2020 PCNs will get specific funding for clinical pharmacists and social prescribing link workers, with funding for physiotherapists, 'physician associates' and paramedics coming in subsequent years.
Not put off by the Coalition Government's failure to find its promised number of extra health visitors, the Long Term Plan for the NHS in England commits to finding 1,000 trained social prescribing link workers by April 2021.
The phrase of the moment is that it is better for health professionals to 'work at scale' - i.e. with a wider base. It is expected by the most senior NHS managers that these PCNs will improve the recruitment and retention of staff, allow better management of financial and real estate pressures GPs face, and above all bring a wider range of services to patients closer to their homes.
Some say this is all about taking services away from expensive hospitals and placing them in cheaper local settings that do not need the costly infrastructure essential for a successful acute hospital (such Salisbury, Great Western and Bath's Royal United Hospitals that serve Wiltshire). We will return to that argument later in this series of articles.
It is still not very clear precisely how these PCNs will work. But it is clear that each one has to have an accountable Clinical Director appointed by its members.
It was expected that this would need to be a GP from one of the networked practices. But it now seems the Director only has to be a clinician - so a PCN could choose a nurse as its Clinical Director. As yet, however, the Director's role has no agreed job description.
Might each PCN need its own management support? The well-respected King's Fund think tank is a bit worried: "The scale and complexity of the implementation and leadership should not be underestimated, and those leading primary care networks will need significant support if they are to deliver the ambitions set out for them." Will the PCN Clinical Directors really get their own local, mini-management teams?
So far WCCG and McKinsey have been working to design PCNs for Devizes, Chippenham and North Sarum. Three more areas will follow shortly "...and local staff will be developed to ensure we have the skills to continue the work across the remaining five areas of the county."
Local staff' - that highlights the all too familiar iceberg the NHS is sailing toward: the staff shortage crisis. Are the PCNs going to be taking staff from existing community health teams or from hospitals? Where are the 'first contact physiotherapists' going to come from?
Added to that there is the problem of real estate - that is the space available for extra services at many local GP practices. A problem we have seen in Marlborough with the Kennet & Avon Medical Partnership's George Lane surgery which proved to be too small to accommodate an NHS Dentist. A problem that could be overcome if the right money was available.
The timetable is tight. NHS England has declared that by 15 May 2019 all PCNs have to submit 'registration information' to their CCG.
Earlier this month the WCCG held a launch event for the county's PCNs. They got a 'full house' - so many doctors attended that it was said appointments with Wiltshire GPs that day (14 March 2019) were hard to come by. There was lots of healthy debate and input.
Much of the information in this article comes from the Interim Deputy Chief Executive's report to the WCCG board meeting of March 26. Unfortunately we know no more as the board's 'full discussion' of the Wiltshire PCN programme took place in the board's Private Session.
This is the first in a series of articles on the new shape of the local NHS - following an introductory report (28 March 2019). Next: how will the Wiltshire CCG fit in now?