With the passing tomorrow of the deadline to sign up to the Primary Care Network DES a Rubicon will have been crossed for PCNs. The rehearsals are over, real money and commitments are at stake. But I want to know, how will they work?
A funding model is in place, a set of PCN duties and payments is agreed, no doubt controversially for some but that’s how it is. A list of professions is now 100% funded by the delightfully named Additional Roles Reimbursement Scheme.
But still I ask, how will they work?
Everything we do in the NHS needs to relate to its purpose which, however it is worded, amounts to helping patients overcome or manage their various medical needs and diseases.
The additional roles must be to help patients, who have needs. Which patients, what needs, when, with what measurable outcomes?
Forgive me if I’ve missed something, but the debates on funding, roles, governance and so on seem to be very far removed from these practical questions.
Consider the patient journey: present to GP practice, GP considers they would benefit from referral to a PCN employed clinician, say a pharmacist. How easily do they refer them? How soon can the patient be seen? How does the pharmacist manage demand from multiple practices? What is the right capacity for each kind of role?
A PCN I spoke to had a pharmacist one day per week in each of the five member practices. Neat, being five, but others will have 3, 4 or 7, and all different sizes. One may be mostly students, another elderly and with very different needs. What if our patient gets referred on Tuesday, just missing the pharmacist who calls at her practice on Mondays? And work or family commitments mean Monday never suits her?
Managing the workflow, demand and capacity for shared roles could be orders of magnitude more difficult than the same within practices.
I would love to know your thoughts on how, or ideas from your PCN. Yes, we are going to try and make it easier so you can make the most of the new resources, do let us know what you would like and watch this space.
PS Last week’s blog looked at return on investment in askmyGP. David Evans replied to me that following their £35k investment in year one, they were saving £100k pa in locum costs. Not bad, indeed typical. Sujit Vasanth commented online “I can honestly say the change to askmyGP has been the most important (and positive) change in our practice in the last 10 years.” Thank you!
A number asked about spreading payments and I’m pleased to announce that we have responded with just that, it’s on the bottom of our Transform Express and it is now standard.