Last year, we saw the emergence of PCNs as the vehicles for the development of primary care and as potential saviours of general practice. Draft specifications of the five PCN services for this year, though phased, have just been published and the deadline to submit your feedback is only 15th January 2020.
These specifications were published during the festive holiday period and one can argue that this isn’t the best time for optimal engagement from the practices.
Nevertheless, the draft specifications suggest a huge influx of demands from the PCNs and the practices, with little clarity on funding. Whilst the PCNs are still grappling with the issue of the status of PCNs as legal entities, inadequately funded time for clinical directors and the shortfall in funding of additional workforce, what’s about to come is an unprecedented ask.
PCN pharmacists, who were supposed to alleviate pressure on GPs and are funded more than one third by the practices, are expected to be vital for carrying out structured medication reviews for 100% of the patients identified.
For my PCN, this works out to be at least half a thousand patients who should be reviewed twice in the year. On top of this, the person carrying out the review must be a prescriber too.
This is an almost impossible task, especially given the shortage of prescriber pharmacists in particular, and primary care pharmacists in general.
This begs the question of why practices should fund even 30% of the pharmacy time (which in reality, is more than 30%, once all the other costs are included) from their own pockets, given there is likely little benefit, if any, to the practices given the demands of this specification.
Risk becoming a tick-box exercise
The care home service specifications demand a weekly review by a clinician and a fortnightly review of patients by a GP, irrespective of the need, especially when we have extended primary care teams in many places, such as advanced nurse practitioners or pharmacists who are very capable of such reviews in most cases.
Besides, there is a requirement for any new resident in the care homes to be reviewed within a week, as well after every admission to the hospital, again within a week. Such rigid time scales and expectations risk a lot of this becoming a tick-box exercise.
Then, there’s the potential of PCNs being responsible for the training of care home staff.
Anticipatory care and personalised care service specifications appear to make some vague promises, but risk significant management responsibilities, including the development of protocols.
A social prescriber who was supposed to reduce demands on GP appointments might now just end up with a lot of administrative functions, and the demands being placed with anticipated numbers seemingly unreal for a typical PCN.
Similarly, the cancer care service expects PCNs to increase uptake of screening, as well as push for earlier diagnosis, but with no clarity on additional resources and how we might just do all the additional expectations and reviews within the overstretched world of general practice.
We haven’t even yet talked about the potential clinical time taken away from the frontline by having a clinical lead for each of these five services. Nor have we considered capacity issues within community services and the system factors outside the remit of PCNs that will have a huge impact on how successful these services end up to be.
Although a lot of this appears well-intentioned, it’s clearly completely out of touch with reality; undeliverable in spirit; and the proposed targets display nothing but a complete distrust with primary care.
Such a prescriptive approach leaves little space for any innovation or genuine local solutions.
Though the feedback questions aren’t quite framed to encourage critical feedback, we must share our concerns and potentially detrimental impact on our ability to care for our patients if this goes ahead in the way it’s proposed.
We must strengthen the hands of our negotiators.
We need resources and staff to help us cope, not what will end up being used for additional work and demands.
And for once, the authorities must work based on trust and appropriate light touch monitoring. Otherwise, a lot of this will end up a tick-box exercise.
Dr Kamal Sidhu is a partner at Blackhall and Peterlee Practice and New Seaham Medical Group; chair at South Durham Health Community Interest Company; and vice-chair at County Durham and Darlington LMC. He writes in a personal capacity.
