Primary Care Networks the year in stats 

PCNs have been established for just under a year. Over the last nine months, they have achieved impressive coverage, with 99% of practices being included within a PCN and a total number of 1250 in England.

The size of PCN’s vary with the smallest being 14,605 and the largest 263,827. This means the average PCN has 48,020 registered patients.

Adrian BrooksPrimary Care Networks the year in stats 
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PCN conference – key themes and audience feedback

The BMA’s second PCN conference in February was a unique opportunity for nearly 400 attendees to take stock a year after the formation of Primary Care Networks in 2019.

Coming two days after the announcement of a package of changes to the GP contract for 2020/21 it allowed delegates to take stock on these changes, question those that negotiated the package and discuss with peers.

We’ve identified some key themes that emerged from the event as well as captured attendee feedback from the event.

Clarity for PCNs

A key takeaway for delegates was reassurance on the service specifications for PCN. These were significantly shorter (3 pages in the agreement) than the version circulated at the end of 2019 (over 20 pages) with two further services being deferred to 2021/22. In addition, all PCN roles will be reimbursed at 100%, freeing up the existing £1.50/head to contribute to management support for PCNs.

Call for investment in infrastructure

The presentation by BMA GPs committee chair Richard Vautrey was enthusiastic about the benefits that the funding changes, pared-back service expectations, and additional roles would bring but highlighted that with these steps forward, other areas risk falling behind. For example, the logistics of accommodating increased workforces will need to be addressed. He called upon the Government to invest in capital expenditure to ensure all practice premises are fit for purpose.

This, he said, connects to the importance of building care across communities. By investing in capital expenditure, the benefits would include reducing duplication of effort and minimising waste. BMA lobbying to increase investment in healthcare infrastructure will continue. Dr Vautrey shared his views on the GP contract agreement in an earlier BMA blog post.

Additional roles

How are PCNs managing the practicalities, successes, and challenges of integrating new roles into a PCN – particularly when they’re not well-known to patients? Speakers at the event gave examples of how their roles had supported the wider practice teams, freed up GPs’ time and provided services tailored to specific cases.

A key message from the event was for primary care to diversify and grow a practice workforce, we need time – giving time to the new roles to build trusted working relationships, particularly if staff are new to the role, recently qualified or split across multiple sites. The speakers were clear, however, that with open discussions and considerate planning, these challenges can be overcome.

More work to do

Areas highlighted by delegates at the event was the need for more clarity on tax and the tax status of clinical directors. Concerns were raised during sessions with HMRC about this and the BMA has committed to ensuring that clearer answers are provided on this in the coming months.

Attendee feedback

Of nearly 100 attendees surveyed after the event, 89% said the overall quality of the event was excellent or good and 80% said it met their expectations.

When asked to describe the event in three words the most common words used were ‘informative’, ‘useful’ ‘engaging’. One delegate described it as ‘pretty damn good’.

Delegates also shared their positive experiences directly. GP Kamilla Kamaruddin said: ‘[The conference was] really helpful to network, share best practices and even share the unknowns,’ and GP Bert Jindal said: ‘[The conference has been] good for networking, setting standards, and useful for calibration.’

Adrian BrooksPCN conference – key themes and audience feedback
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Workforce Planning – webinar summary

The BMA’s Learning and Development team continued programme of webinars took on the area of workforce planning this month covering how to best manage, support and lead Multi-disciplinary teams within PCN’s.

Both webinars were hosted by Dr Krishna Kasaraneni, an executive member of the BMA’s GP Committee, who was joined by guests to talk about their journeys and experiences.

On 12 Feb Krishna’s guest was Dr Tim Morton, Norfolk, and Waveney Local Medical Committee Chair and elected GPC member who talked us through his Multi-disciplinary team experiences.

The attendees learned about how effective MDTs can be in facilitating collaboration between professionals and improving patient outcomes. Tim also talked about the critical success factors (see below slide) for effective MDTs and the benefits of clear team roles, competent leadership, clinical responsibility, and accountability, etc. We have explored the advantages of collaborative teamwork, including continuity of care, the ability to take a comprehensive view of the patient, the availability of a range of skills and mutual professional support.

Critical success factors

On 19 Feb Krishna was joined by Pauline Weir, Physician Associate Ambassador for HEE Midlands and East who talked us through her journey and experiences as a Physician Associate.

Pauline explained to the delegates how physician associates are trained, what they can and can’t do when GP practice-based. We also explored the benefits that a physician associate can have in the GP-led Multi-disciplinary team. Pauline also explained how Primary Care Networks can employ a physician associate to work in your practice.

There is still time to book a place on the Learning and Development course, please sign up here.

Adrian BrooksWorkforce Planning – webinar summary
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Quality Improvement – webinar summary

The BMA’s ongoing Learning and Development team held two webinars that covered the vital areas of quality improvement for PCNs and the journey of a clinical director.

Quality improvement

We began by defining Quality improvement (QI) and discussing its importance in general practice. We talked about system enablers and what can be done at the PCN level. We also learnt about internal and external factors that impact and encourage the right culture for QI to be successful.

Although there are many commonly used tools, we know that many are based on the Plan Do Study Act (PDSA) cycle (see slide below). We did, however, cover, an additional tool that can be used for both small and large QI projects; Process mapping. This activity will help the project team to identify the problems that exist within complex pathways. This should be a team exercise and ideally should involve your patients too. Dr Sian Howell, from Healthy London Partnership, talked about how to start mapping using the example of repeat prescribing.

  1. Decide an area to improve e.g. Repeat prescribing
  2. Put one colour post-it note onto a board per each identified step in the process from start (patients requests a medication) to finish (patients receives medication)
  3. Use another colour post-it note to identify problem points, or waste points in this process for e.g. the use of faxes
  4. You may then want to seek out other data to supplement this ‘diagnostic’ e.g. your typical repeat prescription duration compared to other practices and networks

This creates a shared clarity of your current process and can identify a helpful area to change. If done thoroughly, the exercise helps narrow your focus and enrolls the team in your program of change.

The journey of a clinical director

Our fifth webinar looked at sharing experiences and best practices for clinical directors. BMA trainer Susan Edwards was joined by Sarit Ghosh – Clinical Director at Enfield Unity PCN – one of the largest PCNs in the country with 160,000 patients.

Sarit talked about his journey as a Clinical Director and shared his tips and thoughts on how to set up a governance structure. He also talked about the challenges of creating a super-partnership, and how he found the recruitment process for the additional roles.

Attendees also learned what a typical working week looks like for a Clinical Director and how to fit everything in.

Delegates could also find out what was really important to get right and why and what Clinical Directors should focus on in terms of their professional development.

There is still time to book a place on the Learning and Development course, please sign up here.

Adrian BrooksQuality Improvement – webinar summary
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Takeaways from the 2020 primary care networks conference

Missed the conference this year, or looking for a recap? Read on for a whistle-stop tour of some of the highlights and discussion topics of the day.

On February 8, the BMA (British Medical Association) held its second PCNs (primary care networks) conference, in central Birmingham. Just two days before the conference, the BMA GPs committee England announced it had voted to accept a package of changes to the GP contract for 2020/21. The conference was the ideal opportunity for delegates to discuss the deal and share their views on what the decision meant for them.

There was a real sense of community on the day, with over 350 clinical directors and medical professionals attending. The agenda was packed with presentations and sessions; partnership working, services, finance, LMCs, and workforce considerations. With several breaks and a catered lunch, there was ample opportunity for delegates to network and share experiences.

Introductions

Sessions were aimed at giving insights, practical suggestions and shared best practice. But first, the day began with Krishna Kasaraneni welcoming delegates to the second PCN conference the BMA has held after a successful event in 2019.

The next presentation was by Ed Waller, director at NHS England, and was highly anticipated. With an earlier deal having been rejected by the GPs committee three weeks ago, there was relief that following months of negotiations between the BMA, and NHS England & NHS Improvement, an agreement had been reached. The new deal builds on last year’s five-year deal; two highlights are additional funding for increasing and diversifying the workforce and a paring back of service expectations.

Mr Waller’s presentation also covered PCN stability, the new ‘investment and impact’ fund, the Government’s manifesto pledges, vaccination incentives, improvements to maternity care and GP working conditions.

Managing workloads

Given that a recent BMA survey found that 49 percent of clinical directors viewed their workload as unmanageable, the topic of service specifications was also key. Indeed, Mr Waller thanked delegates for ‘telling them [NHS England] what they thought’ of the original agreement, raising a laugh from the audience. The new contract, he said, showed that ‘the views of general practice were listened and responded to’. The agreement includes a simplification of the three services introduced in 2020/21 and two further services will be deferred until 2021/22, reducing the impacts and expectations on PCNs. (Read the full GP contract agreement).

The Additional Role Reimbursement scheme was another area of change. For 2020/21 the Government will provide 100 percent reimbursement for the roles that fall under the scheme. Further, there are now 10 roles included – physiotherapists, physician assistants, pharmacy technicians, and others.

PCNs now have an opportunity to provide the additional services and care to patients that have been sorely needed, and to create workforces that reflect their individual population needs. The questions asked after Mr Waller’s presentation predominantly focused on these two areas of change, and the theme continued in conversations throughout the day. In particular, the Workforce session gave a practical insight into the range of roles.

Call for investment in infrastructure

Next was a presentation by BMA GPs committee chair Richard Vautrey. He was enthusiastic about the benefits that the funding changes, pared-back service expectations, and additional roles would bring but highlighted that with these steps forward, other areas risk falling behind. For example, the logistics of accommodating increased workforces will need to be addressed. He called upon the Government to invest in capital expenditure to ensure all practice premises are fit for purpose.

This, he said, connects to the importance of building care across communities. By investing in capital expenditure, the benefits would include reducing duplication of effort and minimising waste. BMA lobbying to increase investment in healthcare infrastructure will continue. Dr Vautrey shared his views on the GP contract agreement in an earlier BMA blog post.

Additional roles

After a chance to refuel with coffee, the sessions began. The Workforce session had multiple speakers, representing roles included in the Additional Role Reimbursement Scheme. Social prescribers, physician associates, primary care paramedics, clinical pharmacists and first contact practitioners all gave overviews of their roles, accountabilities, and ways they supported PCNs – and emphasised the benefits each role offered PCNs.

Delegates were curious to learn about the everyday activities of the roles, and the practicalities, successes, and challenges of integrating new roles into a PCN – particularly when they’re not well-known to patients. The speakers gave examples of how their roles had supported the wider practice teams, freed up GPs’ time and provided services tailored to specific cases.

To diversify and grow a practice workforce, we need time – giving time to the new roles to build trusted working relationships, particularly if staff are new to the role, recently qualified or split across multiple sites. The speakers were clear, however, that with open discussions and considerate planning, these challenges can be overcome.

Tax matters

A lunch break gave plenty of time to network (or get some fresh air in blustery Birmingham) before the event turned to cover finance.

The feedback and questions from delegates on this issue were taken on board and were of considerable use to the BMA’s GP committee, NHS England and HMRC. The latter’s representative said he would ‘take this back and raise it as a high priority’ with the hope of getting information about tax to clinical directors in the coming weeks. After a meeting with the BMA, HMRC also agreed in principle to the BMA’s offer to draw up a series of models in which PCNs operate so VAT advice can be offered in the future. We’ll share further information once we have it.

Practical advice for success

In the final session, Neil Parsons spoke about the award-winning PCN for East Cornwall. This was an opportunity for delegates to get a practical example of methods to create a successful PCN. Made up of nine practices in rural locations and serving a population of 105,000, including a high proportion of elderly patients, Mr Parsons noted the willingness between practices to collaborate. As he put it: ‘All nine practices are islands but under the waterline, the land is connected.’

East Cornwall identified several areas that needed to develop as the PCN took shape, including digital infrastructure and services, strong communication and trust with the local commission, workforce investment, leadership development, and partnership working.

It was known early that to ensure cohesion and efficiency between practices, improvements to their digital infrastructure were essential. As a larger group there was more opportunity to negotiate and fund newer technologies, e.g. procuring online consultation software consultations, which has eased some of the pressure on GPs by enabling video links – particularly helpful in rural locations.

Another area identified for development, and a perfect example of the benefits of the new Additional Role Reimbursement scheme was the changing workforce. For example, East Cornwall hired an onsite pharmacist to work across the nine practices, something individual practices were unable to afford.

One of the concerns raised during the day was the financial stability of PCNs. Mr Parsons touched on this during his presentation, noting that one of the key aspects of his PCN’s success was in the time and effort given to building a trusting and communicative relationship with the commissioner, as well as between colleagues across the practices.

To mitigate financial risks, the team also set up a limited company, Kernow Health East. This sets it apart as a legal entity and enables the workforce to be retained for the PCN rather than individual practices. Although this incurred costs, it is a way to ensure stability and legal clarity.

This was an insightful session which shared the challenges faced by practices joining forces, and practical methods to overcome them. Many other delegates agreed with Aileen Tincello, who expressed what others had said throughout the day: ‘It’s really inspiring to hear practical ideas that I can take back to use in my PCN.’

The conference aimed to bring clinical directors and healthcare professionals together, in a sense of unity, best practice, and development. But don’t just take our word for it; GP Kamilla Kamaruddin said: ‘[The conference was] really helpful to network, share best practices and even share the unknowns,’ and GP Bert Jindal said: ‘[The conference has been] good for networking, setting standards, and useful for calibration.’

Adrian BrooksTakeaways from the 2020 primary care networks conference
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GP contract agreement struck

The BMA’s GP England (GPCE) committee has voted to accept a package of changes to the GP contract for 2020-21, which includes funding to attract more doctors to take up partnership roles and expand the practice team seeing patients in surgeries.

The agreement, which builds on the five-year deal announced last year, is the result of months of negotiations between the BMA, NHS England and NHS Improvement and comes three weeks after GPCE rejected an earlier deal.

Draft service specifications for Primary Care Networks (PCNs) – outlining the responsibilities of these groups of practices and community providers in the coming years – have been significantly pared back after widespread criticism from the profession that draft versions published by NHS England and NHS Improvement at the end of last year were unfair, unrealistic and burdened already struggling-practices with unsustainable workloads.

You can read more detail on the deal here. 

The BMA’s PCN 2020 conference in Birmingham on Saturday 8 February will be an opportunity for attendees to hear about the agreed package in more detail from BMA representatives and NHS England on how this will impact and shape the future of PCNs. Attendees can also share best practices, network with peers and access practical support from experts in VAT, HR, legal issues and insurance.

For more information on the event go here. 

 

Adrian BrooksGP contract agreement struck
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What are the insurance implications of Primary Care Networks?

Since Primary Care Networks (PCNs) have been introduced, there has been some speculation about what insurance cover is required.

A GP surgery under a PCN has new and additional responsibilities they’re unlikely to have had before. This has implications for the following insurance risks;

  • Medical Indemnity
  • Directors & Officers liability
  • Employers and public liability

How your structure affects your insurance

Exactly what your PCN need will be somewhat dictated by the structure of your PCN; a flat practice set up, for example, might involve the sharing or standardisation of employment contracts. This could impact on the employers’ liability insurance for each individual surgery.

Employer’s liability is a legal requirement in the UK so if you have set up your PCN as a Ltd company in it is own right, you will need to have Employers Liability under the legal name of that Ltd company.

If you have a flat practice structure, we advise that you inform your insurers of your PCN activity. If you have a lead practice, you may only need to extend the liability cover on the surgery insurance for that lead practice.

As an employer, you’re effectively extending the place of work to your workforce.

Impacts made by decision makers

Whatever structure you have, your PCN will have appointed a clinical director. Clinical directors will have started to and will continue to take on a growing number of strategic decision making responsibilities as a PCN grows. You may also involve practice managers to work together with clinical directors on PCN related activity.

As these responsibilities will be relatively new to these decision makers, it is important to note the potential liability risks. With responsibility comes accountability. A management liability insurance policy offers protection in the event of a director or officer being accused of wrongdoing. This can mean a variety of things including but not limited to the following;

  • Breach of contract with a supplier
  • Breach of regulation
  • Breach of trust with a patient
  • Unfair dismissal of employees

Management liability insurance is designed to cover the legal costs of defending a claim of this nature and also providing compensation if required. If a clinical director or decision maker within the PCN was found to be liable of wrongdoing, their employer (whether that is the practice or a PCN set up as a limited company) would need to cover the legal and compensation costs themselves.

Want to know more?

As the BMA’s appointed provider of insurance services, we’re able to advise members about their insurance requirements for PCNs.

You can find out more about the services we offer or watch our webinar on the topic on our website.

Adrian BrooksWhat are the insurance implications of Primary Care Networks?
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Managing change – webinar summary

Last week the BMA held its second webinar as part of its package of learning and development support aimed at honing your skills as a primary care network lead.

This webinar focused on Managing change and is one of a suite of digital and face to face events taking place between now and April. They are led by the BMA’s team of expert trainers and are designed to help you effectively manage and lead your teams.

The webinar covered these key topics:

  • Understanding how people experience change and what you can do to support them.
  • Dealing with difficult reactions, understanding fears and redirecting difficult behaviour.
  • How to communicate effectively at the different stages of change. Creating the climate for change, supporting and engaging throughout and finally sustaining the change.

Another key area that was considered was the difference between change and transition – a subtle one but crucial in order to ensure successful outcomes for organisations.

The best way to think about the difference is to see change as the way things will be different, whilst transition is how you move people throughout the stages of change to make it work. The visuals below explain more about the three phases of transition and explore in more detail the difference between change and transition.

The Three Phases of Transition Change vs Transition

The next webinar as part of the series this Wednesday is on 22 January and will cover using data to improve population health.

For more information on the Learning and Development package please click here.

Adrian BrooksManaging change – webinar summary
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PCN service specification and GP contract update

The BMA has voted against a contract agreement with NHS England for a GP contract following criticism of the service specifications for PCNs outlining what is expected of Primary Care Networks (PCN)s over the next four years.

Members of the committee, who met on Thursday 16 January, were presented with a package of changes but voted against accepting them. GPC England will now return to negotiations with NHS England.

Details of the package remain confidential.

A separate motion at the GPC committee condemned the original draft service specifications, put forward by NHS England and NHS Improvement in December, and called for a Special Conference of English LMCs (Local Medical Committees) to allow GP representatives from across the country to debate and consider the outcome of contract negotiations.

Since the specifications were released for consultation at the end of December, the feedback from GPs, PCNs, LMCs, and many local and national organisations was overwhelmingly negative, with practices concerned at the levels of workload involved, especially for those networks that were struggling to recruit additional staff.

GPs said the initial service specifications were ‘too rigid’ and were ‘overloaded’ and called for NHS England to provide more targets for areas such as social prescribing, IT and personalised health budgets. See article here. A BMA survey of clinical directors released this week found that whilst PCNs could make a positive difference with the right resources time and practical support they were being hampered by workload constraints.

BMA GP committee England chair Dr Richard Vautrey said:

The message from GPs in recent weeks has been a clear one: proposals put forward by NHS England and NHS Improvement before Christmas have clearly been judged by the profession as unreasonable, and completely unachievable.

“At a time when demand and workload for practices are unprecedented, GPs working on the front line felt these draft specifications piled on more pressure and would undermine primary care networks that were only just getting off the ground.

“This overload would therefore put in jeopardy all of the good work and progress PCNs have already made for the good of both staff and patients.

 “This is therefore not the end of the process, we have a clear mandate from our colleagues, to negotiate a deal that truly benefits and safeguards general practice, family doctors and their patients.”

For the full BMA statement go here.

Adrian BrooksPCN service specification and GP contract update
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What’s next for your primary care network?

Now that you have formed your primary care network, it is time to shape and direct your local vision in a way that truly improves the lives of both your patients and staff.

The BMA is offering a bespoke learning and development package. This is designed to provide PCN leaders a space to share experiences and establish a network of support. In so doing, everyone will benefit and gain from the experience, learning and innovation of their peers.

Given our national remit, we are ideally placed to bring leaders together to maximise your chances of success in these new roles. Through this opportunity the BMA will support you to ensure general practice can meet the future needs your community.

The BMA has been at the forefront of the PCN developments from the very beginning, negotiating the contract, and building a new direction for the profession. The next phase of our development was to work with clinical directors and leaders in the field to create a programme of learning and development tailored to meet your needs as you embark on this journey. The programme will ensure we all learn from what has gone before, share best practice and lessons learnt to help achieve the ambitions of PCNs by allowing you to flourish in your lead role. We will achieve this by bringing together experts and clinical leaders to show how innovation and new ways of working can help your PCN.

We are offering masterclasses that will give access to both clinical and non-clinical experts to look at strategic planning, workforce planning, and leadership and management. Wrapped around the masterclasses will be a series of webinars and e-learning modules offering crucial insights and opportunities to engage, question and find ways forward that work for you and your PCN.

This bespoke package will be as reactive as it is informative, with your needs at its core. The programme runs from January 2020 to April 2020 and over four months we will provide a framework to your learning so you can plan and manage your workload. Each topic is designed to tackle the current issues and will build on your professional development so that you can set yourself up for success in your respective leadership roles.

The masterclasses are made up of 4 sections taking place across 2 full days and have been designed to enable peer group interaction and learning. The last session will be personalised and offer 1-2-1 career coaching clinics and additional seminars that respond to emerging issues and themes.

There will also be opportunity to learn about new developments across the country to aid innovation in your practice and provide an opportunity to share best practice with others. These masterclasses will be available in Bristol, Leeds and London. The will extend the webinar and e-learning support that is part of our offer. Responding to your needs, we will also provide the opportunity for a virtual conversation on a hot topic relating to issues emerging from the masterclasses. These online hot topic conversations will allow you to address issues you are exploring in the moment.

As we head into the busy winter months there could be no greater reminder that now is the time to innovate and develop general practice – to bring together the best ideas and learnings from around the country and build a more sustainable profession which can deliver better care in an increasingly different environment. Our bespoke package will give PCN leaders the best opportunity to respond to these changes.

Maeve Regan is Learning and Development Product Manager at the BMA

Learn more about how we can support your PCN

Book your place on our PCN conference in Birmingham, February 8 2020

Sian HeaphyWhat’s next for your primary care network?
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