Look Who’s Talking: Primary Care Networks
Primary care networks (PCNs) are the current hottest game in town, but not everyone knows about these huge changes to healthcare delivery. This week I was stunned to meet a GP who actually hadn’t heard of them at all, as most should have! However, it turns out he was from Scotland where for once they are not the ‘guinea pigs’ so I will forgive him. Although most GPs should know what they are, I suspect a lot of people in primary care and the wider world are not yet aware of them.
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n case you don’t know what a PCN is, let me explain. Every GP practice in the country has been offered the opportunity through a DES (direct enhanced service – extra money for doing something) to form a PCN.
Dr Neil Paul www.drneilpaul.blog Dr Neil Paul is a GP partner in Sandbach where he delivers 5 clinical sessions and runs a clinical research team. He is a PCN clinical director, a GP Federation Executive, and a board member of CCICP (a community services provider), as well as a shadow board member on the Cheshire East ICP. He runs a company supporting other PCNs and GP Federations called Howbeck Healthcare and also runs CheshireGPed which puts on evening educational meetings for GPs in the area.
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The idea is based on the National Association of Primary Care (NAPC) primary care home model, which states that health services should be delivered to populations of around 30,000–50,000 people. This is the ideal size for having enough of most conditions to make doing something worthwhile, without being so big as to make it difficult to manage. Ideally, PCNs should be geographically co-located and form natural populations. This enables place-based care, which is the other buzz term we are hearing a lot. This is the basis for forming integrated care partnerships (ICPs), which are the bodies that need to think in these delivery units. An ICP is another reorganisation in which all the providers in an area – including acute, community and primary care – are
put in a room, given a set amount of money and told to get on with it. The idea is that they will do a better job of it than the old commissioner/provider split. It’s all based on the accountable care model made popular in the States, and there are lots of publications from organisations like the King’s Fund that provide information about it. In my opinion ICPs are a good idea; it seems to work in the States. However, once formed, they seem to take two to three years to really start delivering results. This is partly because at first they concentrate too much on secondary care and not enough on primary care and the screening, public health agenda. So far, more than a thousand PCNs have been set up, which goes to show you can do anything if you incentivise it with money, and fewer than ten practices have refused. How happy the PCNs are about forming, and whether they are delivering anything significant, other than the bare minimum that is in the DES contract, remains to be seen.
