The success of a PCN has often been linked to the employment of a network manager. Where the relationship between CD and PCN manager is strong, the PCNs tend to function better, according to experts.
PCN managers generally feel that their PCN has had a successful impact across a range of factors despite there being work left to do. Our survey suggests that PCN managers also feel supported in their role by the wider teams they are working with.
Among respondents working in PCN management roles, there does appear to be a fairly healthy level of job satisfaction – in fact, 80% told us they were satisfied or very satisfied with their role.
That is not to say there aren’t frustrations, including around keeping everyone happy and motivated. One commenter noted: ‘I enjoy my job but there is a battle to get practices (GP partners) to let the network build and utilise ARRS funding to increase capacity collaboratively.’ Another pointed out that the job was satisfying but it comes with ‘constant anxiety’ about the certainty of PCN funding.
Similarly, a large majority of respondents (90%) said they feel supported and valued by the CDs they were working with. This feeling extends to others within the PCN with 70% feeling valued by other practice managers and 60% saying they feel supported by other practice staff and GPs. In fact, very few answered in the negative to this question. Overall, most of those in the PCN manager role 90% feel their job has had a direct positive impact on the successful working and running of their PCN and 65% have the same feeling when it comes to improved joint working and patient care.
The results show that 60% believe their PCN has increased patient access and the same proportion say the PCN has improved care for patients. No one who responded said that PCNs had been very unsuccessful at this. As has been shown with most other staff groups, including CDs and GPs themselves, there is less support for the view that PCNs have freed up staff time. Only 40% of the managers we asked said this was the case.
One of the key aims of PCNs when they were conceived was to improve health inequalities by interventions targeted to the specific needs of their populations. They have been incentivised directly for work in this area. Among PCN managers, there is some agreement that PCNs have been able to have impact here, with 55% believing they have success or have been very successful in this area. While there is a similar level of support for how well PCNs have been able to take on digital transformation after the inclusion of the digital transformation lead in the 2023/24 network DES, one in five believe this has not been a success story with just 10% rating this as very unsuccessful.
The real positive story, at least from the perspective of practice managers, has been the recruitment and retention of ARRS roles. This is supported by the figures in one sense which do show a mass movement of a variety of roles into primary care since PCNs were established. But it cannot be ignored that there has also been money that has gone unspent because PCNs were unable to use all that had been allocated. Among managers, 70% believe that PCNs have been very successful in the ARRS drive with another 20% saying there has been some success. No one rated this in the negative.
Seema Gater, digital and business manager at Whitfield PCN, says the idea behind PCNs was to alleviate the workload of general practice, but she adds, ‘I don’t think this has been universally achieved’.
In her experience, there is still a sense of ‘us vs them’ from general practice staff in some surgeries, creating an uncomfortable working environment for the ARRS staff.
‘This situation has improved with targeted inductions for new ARRS staff and extensive shadowing of traditional primary care roles. We have been striving to integrate the ARRS staff as an extension of the practice team, but there is still work to do here.’
Pay for PCN managers’ roles appears to be more of an issue than the job itself. When asked about this, only 40% said the role was adequately reimbursed.
The latest version of the PCN Network contract rolls the PCN leadership and management payment into core funding and our survey asked network managers about the impact they thought this might have. The majority – 60% – thought it could mean lower pay.
Robyn Clark, director of IGPM and managing partner at Kingswood Medical Practice, Bristol, said: ‘Like with practice manager pay, there is some disparity between PCNs on the level of remuneration for the role. There is also some disparity between what the role entails and we hear from our PCN manager members quite the variety of different tasks and duties that each PCN manager is expected to complete.
‘Some PCNs have utilised the funding for the digital and transformation lead role under the ARRS scheme to pay for their PCN managers, with some maximising the full available budget and others not. There has been concern from some of our members that the rolling in of the leadership and management payment into core funding might lead to a disinvestment in PCN manager time, with practices feeling the financial pinch more than ever this year and potentially looking to use this money to top up practice coffers. It’s difficult for us to comment on pay levels as they differ so vastly between PCNs.’
Interestingly, 60% of PCN managers who responded to the survey had not previously worked as practice managers but had come from other management roles, mainly in the NHS.
A quarter of PCN managers who responded are also practice managers. Among this group, it seems common to work part-time in both roles to accommodate them.
Practice managers
Among practice managers more widely, there is slightly less positivity about the impact PCNs have had, with 49% rating them as successful in improving care for patients and 52% rating them successful in increasing patient access. Half of practice managers said recruitment and retention of ARRS roles had been a success. A practice manager from West Yorkshire commented that ‘Money is being spent but the rest of the practices have no idea where, decisions all made by CD, nothing is shared including accounts or finances, staff retention is very poor, quality very poor.’
PCN finances is an issue that has been recently flagged by experts from the Association of Independent Specialist Medical Accountants (AISMA) who urged practices to double-check their income to ensure they weren’t missing out. This was also backed up by PCN CDs who branded it as ‘incredibly difficult’ to navigate PCN finances.
Another respondent pointed out, ‘How can PCNs be graded on freeing up GP time when activity has increased by 25% at least?’
The introduction of this new breed of manager into primary care has had some impact on the practice manager role with 35% noting it as positive, 28% disagreeing and 34% remaining neutral on the matter. Most do not think it has made their job harder. While the role does not appear to further collaboration outside the PCN, a majority of 57% agree it has further collaboration between practice managers within the PCN.
Robyn Clark said: ‘I think what these figures demonstrate is less about the role of the PCN manager and more about PCNs as a whole. There are many PCNs in the country that work well together and have done some really innovative and collaborative work, but there are also many PCNs that have been unable to achieve the same for a variety of reasons. Likewise, the role of the PCN manager may have been well integrated with practices in areas where the PCN is working well, but perhaps less so in areas where this has not been the case.’
For practice managers as a whole, there are also questions about the future of PCNs, with a third saying they should be scrapped and a quarter saying they were unsure. Only 40% said they should continue.