Actions not words: tips on getting things done in a PCN

The Confederation PCN conference is a highlight in my PCN calendar, I have the pleasure of seeing old faces from ‘PCN land’ and meeting new and interesting people from across the system. The event is about primary care at scale, this year it was focused on the way we work together and how interfaces can be improved.  The day also coincided with the 2024 contract changes, which made for an interesting backdrop to the conversation with NHS England national director of primary care Dr Amanda Doyle.

I was invited to present in a session about ‘interface working’ following on from my work on the integrated urgent treatment centre (iUTC). Often it is the questions and comments at the end of the presentation that are the most telling. I was surprised to find a small queue of people who were genuinely interested in how working as a collaborative could improve patient care.

The themes of the questions were roughly the same, ‘How can we get disparate groups of the system to work together effectively? How can we get PCN members to make decisions? How can we get people to stop arguing and start doing?

The following day I was chairing our annual strategic PCN board meeting, and I reflected on the questions I had been asked and how we did it?  So, here are my top tips on how to get things done in the crazy system in which we work:

1. Flexibility is a USP. Primary care will always have the flexibility to change and innovate more quickly than any trust or ICB.  This needs to be considered when the lead provider is decided and it needs to be a USP of all contractual negotiations involving PCNS/federations.
2. Stick to what you know. I have had my fingers burnt trying to change things I did not fully understand.  I know and understand GP services, there are other members of the system who will understand their roles and services better than me.
3. Vote. When our PCN/federation/steering group agendas are circulated they are colour coded. Everyone knows ahead of time who is eligible to vote and what they will be expected to vote on. If they have not read the papers then they are expected to abstain, but the vote is not carried over. People soon learn to read the papers.
4. Minute everything. We have a personal assistant who is excellent, she was recruited early on and takes minutes on every meeting we have. We know exactly what was discussed (when and where), the actions to be taken and the formal agreements made, it has saved so much time.
5. Step back. If there is a lead provider who is genuinely better placed than your organisation to achieve the intended outcomes accept that working in partnership is the best option rather than being the lead provider. We need to stop squabbling over whether the contract should be held by the federation or the PCN, it should be held by the best organisation to deliver.
6. Block out the noise. It is easy to get sucked down rabbit holes, everyone has their own thoughts and interests. In my view the PCN boards and federation boards should be setting strategic direction and allowing operational teams to get involved with the details. If other board members want to spend their weekends obsessing over details, then that is up to them, but I think there are people far better placed than me to make things work on the ground.
7. Risks can bring rewards. I have talked about this before but it is a recurring theme, there is risk to embarking on new projects and we can not mitigate against every eventuality but using the PCN/federation as the vehicle for innovation changes the risk and the rewards can be enormous, not financially but in terms of having a voice in the system.

My impression is that the new contract has not landed well, and the BMA understand the legality of what we can/cannot do to fight its imposition, again I am willing to be advised, I do not have the solution to this. However, our PCN is less affected than other areas as we did take a risk and took on additional contracts, it is worth doing if we could stop talking and start doing.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.