Since PCNs were introduced five years ago there have been a list of fundamental issues they have been asked to address. Some of this has been in place since the start, including tackling health inequalities and introducing a wider team to support practices through ARRS.
During COVID, they quickly shifted to delivering a highly successful mass vaccination campaign. Other priorities have been introduced since the pandemic, most notably the concept of integrated neighbourhood teams, first introduced in the Fuller Stocktake in 2022 and still in their infancy in many places.
While access has always been something for PCNs to address, the focus on this has also intensified in the past couple of years, including through digital transformation. Fuller noted in her report that inadequate access to urgent care is having a direct impact on GPs’ ability to provide continuity to those patients who need it most. Primary care teams are stretched beyond capacity delivering record numbers of appointments. With the move from CCGs to ICBs two years ago, there is an opportunity for a ‘radical overhaul’, the report said. PCNs need to evolve to develop integrated neighbourhood teams bringing together health and social care professionals as well as the voluntary sector across a footprint of 30,000 to 50,000 patients. Same-day access hubs for providing urgent on-the-day acute care across a PCN have been proposed to help free up GPs for more complex ongoing care.
More recently the announcement of an ICB run pilot across 20 or so PCN sites sees them at the centre of evidence gathering for understanding the difference between demand and capacity.
ICBs
Across all those we surveyed, there are mixed feelings about the move to integrated care systems and PCNs that has happened since 2019. The largest proportion of respondents, 31%, felt neutral about it, with a quarter feeling positive or very positive. In all, 15% felt very negative and 23% felt negative about the changes.
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Those negative responses are likely to be tied up with the finding that 69% of staff across professions said the changes had increased their workload. While half disagreed that the changes had increased the ability of primary care to influence commissioning decisions.
The results showed some support for the success of PCNs in improving collaboration between GP practices, with 39% backing this idea compared with 31% believing this had not happened. When it came to improving the collaboration between primary and secondary care services, only 17% said PCNs had been able to do this. In terms of maintaining continuity between primary and secondary care, just 16% of respondents rated it as effective, with GPs the group most critical of this.
Responses from PCN CDs suggest that just over half were already part of an integrated neighbourhood team, yet there was a disconnect here with GPs, of whom only 25% said this was in place. Among CDs, there was limited support for the same-day access hub model with only a third agreeing on this point. By contrast, 42% disagreed or disagreed strongly with this approach. Support was even lower among GPs, 21% of whom agreed with same-day access hubs and 58% disagreeing.
Dr Zoe Archer, a GP and PCN care home lead in St Leonards-on-Sea, East Sussex, notes that communication and engagement between practices can be challenging. ‘We are a large PCN with nine surgeries and around 100k patients. We hold engagement meetings, but it is difficult to get information through to everyone. This will hopefully improve.’
The survey results do raise questions about whether ICBs are engaging effectively with primary care. GPs had often been at the heart of CCG commissioning and had built up relationships over many years. Two years in, the move to ICBs does seem to have disrupted this connection. PCN CDs have more positive views on this with 46% saying their ICB is highly engaged with primary care and the vast majority aware of who represents them. But 54% disagreed this was better than with CCGs. The engagement that some have seen has not translated into a belief that ICBs will direct more funding into primary care with only a quarter agreeing this will be the case. Among GPs, only 11% agreed the ICB was highly engaged with primary care and two-thirds believed engagement had got worse since ICBs came in. GPs are particularly sceptical that ICBs will direct more funding their way, with only 5% agreeing with this statement. One GP in the East of England who wished to be anonymous noted: ‘Our ICB is clueless about and hostile to primary care, totally focused on secondary care.’
GPs who have a PCN role are more positive about the relationship with new commissioning structures with 37% stating they are highly engaged and 32% believing this has improved since CCGs. These responses may well reflect the direct experience of those in leadership roles while GPs still feel a certain amount of disconnect.
Seema Gater, business and digital manager at Whitfield PCN, adds that it feels ICBs are not overly concerned with what is happening at the grassroots level. Getting their engagement and recognition can feel like searching for a golden ticket. The CCG was more accessible for discussing issues and visiting practices, which improved relationships.
Access
The network DES also tasks PCNs with providing enhanced access which aims to standardise services across the country, make greater use of the ARRS roles in provision and boost capacity. It also involves digital transformation providing more routes for the patient to access primary care and a broader set of services. Since 2022, PCNs have had to deliver 6.30pm-8pm weekday appointments and 9am-5pm Saturday slots. Each PCN had to assess how they would do this for the demands of their population and what services or skill mix and appointment types would be most appropriate to offer.
While overall, the view of how successful PCNs have been in increasing access is positive, it does vary between staff groups. Those in ARRS roles are most likely to believe PCNs have had success in increasing access with 63% responding with a positive view. More than half of practice managers and CDs also think PCNs have been successful or very successful on patient access. This then drops to 44% of nurses, 34% of GPs with a PCN role and 16% of GPs overall.
The impact of the ARRS scheme is positive when responses of all professions are combined. The impact on patients comes out on top with 52% rating it positively, followed by 48% rating it as a positive for the practice and 39% for practice staff.
Part of enhanced access was making the most of the ARRS roles that have been introduced by PCNs. There is a variety of opinions on which have been most successful with pharmacists, first-contact physiotherapists and care co-ordinators rated most highly in our survey.