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