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Primary Care Networks

One of the joys of working in the Public Sector is the knowledge that transferring between different organisations will result in new acronyms to learn. As someone who transferred to Audit Yorkshire from Local Government a PCN to me meant a Penalty Charge Notice – some of you may have received such a “gift” from your council in the past.  Whilst the NHS can also issue such a notice for prescriptions, it has more recently become an acronym for a Primary Care Network.  What does that mean?

Legislation

Under the Primary Medical Services (Directed Enhanced Services) Direction 2019, the Secretary of State for Health & Social Care specified – “NHS England must establish and operate a Network Contract Directed Enhanced Service to integrate care by the formation of Primary Care Networks (PCN) to deliver care in a more personalised way”.

What is a PCN and what will it actually do?

Led by a Clinical Director they are more than a cluster of GP’s working together and represent a fundamental shift in the provision of health and social care. PCN’s came into existence on 1st July 2019 once they could demonstrate: 

  • The PCN covered 100% of the geographical area
  • Every GP practice had been included
  • Each PCN managed 30,000 – 50,000 patients (although currently around 40% breach this upper limit)

Operating under a Network Agreement signed by all PCN members, GP surgeries will increasingly “work together within a primary care network to share community nursing, mental health and clinical pharmacy teams, expand diagnostics and pool responsibility for urgent care and extended access.” NHS England – Forward View Next Steps (March 2017).

This should improve the ability of practices to recruit, retain staff, manage financial and estate pressures; provide a wider range of services to patients with access to a wider number of professionals; and to more easily integrate with the wider health and care system.

Service improvements via the PCNs could include areas such as:

  • Medication reviews
  • Proactive care
  • Support for early cancer diagnosis
  • Locally agreed actions to tackle inequality.

For patients this could also mean: 

  • They tell their story once but it is heard by a wider range of professionals
  • A change in the way they Interact with GP services, including greater use of technology, telephone based consultations as well as traditional face to face meetings
  • Clinicians will be better placed to share best practices and knowledge across a wider network

The role of the Clinical Director

Each PCN must employ a Clinical Director to provide strategic leadership. A practising clinician, they will work closely with member practices and NHSE to develop, support and deliver local improvement programmes aligned to national priorities.   Other responsibilities will include:

  • Representing their PCN at CCG level clinical meetings
  • Developing the PCN’s Conflict of Interest arrangements
  • Acting as the link between general practice and the wider health system

How can Internal Audit support PCN’s?

As PCN’s only came into existence in July 2019 it is too soon for these to be audited as most service requirements will not be introduced until April 2020 onwards. However numerous issues and risks will need to be considered: 

  • Guidance currently permits the Clinical Director to sit on the Governing Body but will demands on their time have a negative impact?
  • Once they are more established the PCN can be the provider and commissioner but how will this conflict be managed?
  • How will each GP Practice fully understand the service provision available within the new network?
  • How will they ensure a consistent level of engagement across the PCN?
  • How adequate are the governance arrangements for the PCN and its supporting partners?
  • How suitable are the data sharing and data processing arrangements for patient records?
  • How will they ensure the income received per patient will be spent in the right areas, especially when they do not need to provide any evidence to the CCGs or NHS England?
  • Where will they receive their assurances from in terms of their internal control environment?

Audit Yorkshire will therefore continue to monitor developments via our Project work and will look to develop an approach to the numerous issues as the PCN’s mature.