They will do next to nothing to remedy the serious shortcomings highlighted by the pandemic: a depleted NHS, a privatised social care system, with over-centralised, fragmented and part-privatised communicable disease control and public health systems. Joined-up legislation is needed to revitalise local authorities and to rebuild public services.
If you do not want a market system and you want to run a public service, you need a different form of legal structure.
The case for it is as strong as ever. Peter Roderick , principal research associate, Newcastle University. Allyson M. Pollock , professor of public health, Newcastle University. We welcome submissions for consideration. Your article should be clear, compelling, and appeal to our international readership of doctors and other health professionals.
The best pieces make a single topical point. They are well argued with new insights. Almost GPCCs have already been set up. Lansley says GPs know their patients and their local hospitals, so are best-placed to decide on treatments. Family doctors know better than PCT managers, says Lansley, though many trust staff are experts in particular areas of healthcare, such as cancer.
That transfer will shed 24, PCT jobs. What difference will patients notice when the new system starts? Probably not much at first. Appointments to talk to a GP will not be altered. But GPs may refer patients to a wider range of treatment centres because of the government's policy of letting "any willing provider" — be that NHS, a private group, or the third sector — provide healthcare paid for by NHS funds.
Lansley says his switch to GP-led commissioning is a logical extension of two projects: GP fundholding, a Tory government initiative in the early s, and practice-based commissioning, introduced by Tony Blair in To ensure representation from all PCNs within an integrated care system, networks will likely need to work out an approach to fairly and collaboratively represent themselves.
This might include establishing a group for PCN clinical directors within an integrated care system, from which one or more representatives are nominated to the integrated care system board, contribute views from PCNs to influence integrated care system policy, and report back to local PCNs and constituent practices. The price of increased collaboration and fairer representation across PCNs may be increasing bureaucracy, and taking time away from the core functions of PCNs at neighbourhood and community level.
Evaluation of the implementation and early development of PCNs reveals that they have established themselves swiftly and made good progress in getting new services under way in a challenging context. But PCNs are at risk of having too much expected of them too soon.
Their fragile management and organisational arrangements may come under undue pressure if required to fulfil too many nationally specified service requirements, particularly when still establishing local arrangements to strengthen and extend primary care. Other areas fell back on previous forms of local collaboration instead — for example where an existing GP federation or out-of-hours cooperative was better able to provide a now-necessary service.
The pandemic derailed the timeline for the introduction of some aspects of the PCN service specifications some such as anticipatory care were delayed, while others such as enhanced care home support were brought forward.
Furthermore, although money remains available to PCNs, the pandemic has made recruiting additional roles more challenging. In winter —21, as consultation on the new legislative proposals continues, PCNs are playing a central role in delivery of the COVID vaccine programme, with no clarity as to how long this may last, nor what impact it will have on core PCN activity.
Establishing PCNs as well-functioning networks — engaged with and responsive to the needs of their local communities, and working with other NHS, social care and voluntary sector providers — was always a challenge when working to tight timelines. The pandemic has monopolised the second year of PCN working and seems likely to continue to impact the third.
The legislative changes proposed by NHS England are intended to come into effect in , but will likely cause disruption before and after implementation, as NHS managers and leaders become busy doing what they have done so many times before: planning and enacting a reorganisation of local governance, management and other structures. If the new proposals are implemented, the entire lifespan of PCNs, as set-out in the NHS long term plan, will be played out against a backdrop of disruption.
This has been described in previous studies of primary care organisational development. At best, disruption from the likely organisational changes in the NHS will be an opportunity cost for PCNs — time invested in dealing with the effects of system change that might otherwise have been spent elsewhere. At worst, system reform may destabilise fledgling PCNs, stretching the limits of their resilience.
In addition to fulfilling their contractual requirements, PCNs are expected to contribute towards a loftier goal: a more integrated local health and care system, where the NHS works with local government and other community partners to improve population health and reduce inequalities.
This vision is what attracted many early supporters of PCNs to become involved. The proposals do not contain detail on the role PCNs are to play at place level, but there is a clear expectation of expanded responsibilities. As collaborations between general practices, PCNs are already provider collaboratives.
How PCNs will function within these additional collaborative arrangements — and whether doing so will create a further governance and management ask — is unclear. Experience suggests that local partnerships between health and social services agencies are complex to manage and deliver — with expectations often exceeding what is achievable Glasby et al , Hayes et al In some respects, PCNs are caught in a bind.
Fail to represent themselves effectively at system level, and PCNs may risk losing out when key decisions and resource allocations are made. But the need to have system-level representation will present an opportunity cost for PCNs. PCNs are small general practice collaboratives with big and expanding to-do lists, including the pressing need to recruit new roles to fulfil their contractual requirements, and needing to secure and sustain the engagement of local primary care teams.
As such PCNs may find themselves drawn away from their original purpose — delivering local care at neighbourhood level, and shoring up general practice in the process. This is a dilemma witnessed on countless occasions with prior primary care-based collaborations , whether focused on commissioning eg GP fundholding, practice-based commissioning, GP commissioning or provision eg personal medical services, primary care trusts.
The long history of attempts to reform NHS architecture features familiar refrains. Time and resource are expended on the process of organisational change, managers and clinical leaders are often diverted from the vital and more difficult work of changing and improving local services, and promised financial and service benefits are rarely delivered at the anticipated scale for examples see Mays et al , Edwards , Exworthy et al The NHS is good at coming up with new initiatives, setting up structures and governance arrangements, and responding quickly to central policy direction.
It is much less good at letting new primary care organisations focus on local priorities and giving them the time years not months to get going and prove themselves, developing a true sense of local ownership of primary care development. And the NHS has struggled to identify and apply meaningful measures of success for newly forming primary care organisations. Much learning could be gained from New Zealand, where the independent GP-owned and led practitioner associations of the s and s continue to thrive , having morphed into primary care provider and support organisations with a strong focus on population health.
These organisations have been able to pursue a mix of local and national objectives, received additional funding for expanding responsibilities, and continued as locally-led, GP-governed entities.
This risk will be magnified if the need to straddle both neighbourhood and place results in PCNs merging to become larger primary care provider organisations.
The experience of primary care groups and trusts from to is salutary here , as is that of practice-based commissioning. Change in the NHS landscape seems inevitable — and the emphasis on collaboration at the heart of the new proposals fits with the existing direction of NHS policy set out in the NHS long term plan. But the proposals also carry risks for PCNs. PCNs will need to find their place within newly established integrated care systems, while also continuing to develop and strengthen local primary care — all in the context of additional pressures created by COVID To help address the risks described here, NHS leaders should consider the following as they further develop their plans for new NHS legislation over the coming months:.
The authors are grateful to Health Foundation staff, in particular Sean Agass, for their assistance with this publication. This briefing helps to explain what the implementation of primary care networks PCNs will mean for Health Foundation HealthFdn. We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.
Copyright The Health Foundation
0コメント