What is a 'Primary Care Network'?
Since the NHS was created in 1948, the population has grown and people are living longer. Many people are living with long term conditions such as diabetes and heart disease, or suffer with mental health issues and may need to access their local health services more often.
To meet these needs, practices have begun working together and with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in primary care networks.
Primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively care for the people and communities they serve. Where emerging primary care networks are in place in parts of the country, there are clear benefits for patients and clinicians.
(Source: NHS England - Primary care networks)
Watch the short animation that explains the concept of primary care networks (PCNs) and how this new way of working enables health and other services to work together to provide better access for you.
What it means from a medical professional's point of view...
A message from Dr Satheesh Ramasamy - Clinical Director of the North Buckinghamshire Primary Care Network:
"You may be aware of the advent of Primary Care Networks (PCN). PCNs are designed for GP practices to work closely with one another and also various other health, social and voluntary sector organisations to provide comprehensive proactive care for people and communities. The practices in the North Bucks PCN look after a total of 68,000 patients and these practices are The Swan, Norden House, Whitchurch, Wing, Ashcroft, Edlesborough and Waddesdon. Our practices will continue to work independently in many ways, but where we can offer additional services we can now do this by sharing staff and delivering this more locally to you, our patients. We meet every month and we have representatives from all of our health and social care colleagues and a number of patients who are involved at all levels of decision making. We are excited to be part of this new initiative, which we expect will bring discernible benefits to our patients."
What it means from a patient representative's point of view...
A message from Frank Donlon - Member of the Patient and Public Engagement Group
"Historically the Aylesbury Vale North GP Locality has had strong public/patient participation. Representatives from each Practice PPG have been invited to attend and contribute fully as equal participants in the monthly locality meetings. This form of engagement developed as part of the introduction of Clinical Commissioning Groups (CCGs), which replaced the previous Primary Care Trusts (PCTs).
At first the meetings were split into Part 1, open to all, and Part 2, closed, where only the GPs discussed more “sensitive” issues. However, it quickly became apparent that this was an artificial distinction, because in fact, GPs could not discuss individual patients due to patient confidentiality, and were reluctant to discuss commercial issues which would disclose too much to other practices. The agenda, rightly, became focused on commissioning, patient pathways and provider performance, but also included comparative data about the practices themselves in terms of referrals and prescribing. The patient representatives, who by then had shown their added value, were soon invited to stay and participate in the whole meeting. This was a very significant act of trust by the GPs who were risking that any unguarded comments could be taken out of context and used against them. The patients acknowledged and respected this risk and there has never been any breach of that trust. We have received many accolades for this inclusive and transparent approach to public/patient engagement.
One of the barriers to public/patient participation in any NHS committee structures has always been the plethora of TLAs (three letter acronyms) and the combination of clinical and managerial jargon. Sentences, paragraphs and even whole meetings can read and sound like a foreign language. But, like any language, it can be learned and indeed there are many native speakers who reside in our communities. Our patient representatives include former practice managers, retired senior clinicians, management consultants, NHS Non Executive Directors, Expert Patients as well as former senior managers from public, private and third sectors who may not yet speak the language but can offer very different insights and skill sets. Our demography is not unique, and many areas would be amazed at the depth of public/patient talent that is available to them on their doorstep.
So, as CCG Localities now give way to Primary Care Networks (PCNs) we must consider whether and how we can retain that talent. We are fortunate in that our locality, which comprised 6 practices, will now form the new network with the addition of a nearby 7th practice. But we must recognise that there is a fundamental difference between a locality and a network. Each practice will continue to be independent, but via the network, will share patients, records, staff and finances so that, in a sense, the network becomes an NHS provider body in its own right. This introduces accountability issues including data sharing protocols, patient confidentiality, employment and performance management, contract management, and shared financial implications of decision-making. The network is required to have a governing body, which will be responsible for the oversight and governance arrangements in such matters. This cannot be done in an open meeting.
There is additional complexity in that, as part of our semi-autonomous development, in early 2017, four of our locality practices formed a GP federation, Medicas, in anticipation of bidding to become a Multispecialty Community Provider (MCP). The MCP aspiration was overtaken by the introduction across Buckinghamshire of Integrated Teams, and the North Locality opted to become a pilot project. Our partners include community nursing teams, mental health providers, third sector providers and our own Patient Support Team.
Our network contract recognises that Medicas and our Integrated Team are part of our network. As a private limited company, Medicas, which now includes all 7 network practices, already has its own board of directors and governance arrangements, including a patient representative non-executive director. This will now be mirrored by a board of the same directors for the North Bucks Network. The Board/s will meet in private once per month, so fulfilling the governance requirements, but excluding other stakeholders.
To address this deficit, all of the other stakeholders in our network including the existing Public/Patient representatives and the Integrated Team partners will be invited to a monthly Network meeting which will immediately precede the joint PCN/Medicas Board meetings. It is intended that the network meeting will follow the established format of the previous locality meeting and will be a forum in which to exchange information, discuss ideas and raise any issues pertaining to the network. Although superficially this resembles the Part 1 and Part 2 meeting concept, a key difference will be that Part 1 will be a public stakeholder network meeting, not a PCN Board “meeting in public” whereby stakeholder input could be limited and managed.
Our hope is that these arrangements will enable us to meet our legal requirements whilst maintaining the wider and deeper participation of our staff, public and patients. We will review the arrangements after 9 months, in March 2020."