An equal shot

Primary care at scale can improve patient care if it is properly resourced, argues Victoria Vaughan 

Variation in healthcare is not new. The NHS is the world’s biggest employer of highly skilled professionals. It is complicated, it is fallible. While there is, and always should be, an aspiration for care to be the same excellent standard across the system, attaining this is another matter. There are under-doctored areas and underserved communities. There are increasing demands, waiting lists and disease burdens. There is not enough funding. There is Covid.

Tackling health inequalities has always been part of the PCN remit. It is one of the service specifications set to come this autumn, although it remains under negotiation. And a report from the NHS Confederation’s PCN Network, Primary care networks two years on, found that 87% of PCN leaders believe no service specifications should be introduced in 2021/22.  

But a delay doesn’t mean work will not get under way. PCNs are small and agile enough to know the issues, yet big enough to tackle them. As our autumn issue cover feature illustrates, many CDs and GPs are already making a difference, providing services to reduce health inequalities.

But they need support. The problem set out in The Marmot Review a decade ago is still there and has been exposed by Covid. Studies carried out in the pandemic found an increase in domestic abuse, a worsening of mental illness, loss of income through self-isolation, an increased burden on mothers and an impact on the mental health of NHS staff. The challenges are now greater. 

In a recent US think-tank report Mirror, Mirror 2021: Reflecting Poorly, the NHS lost its ranking as the top- performing health service, falling to fourth out of 11 affluent countries. In the area of income-related disparities, the NHS also slipped from top spot to fourth. These findings cannot be ignored. The problems health leaders have been highlighting for years are having an impact. This is, of course, all set against the new Health Bill. Primary care at scale can improve patient care if ICSs grant proper resources.

There is also a valid concern that PCNs could exacerbate inequalities as discussed in our roundtable on the additional roles reimbursement scheme (ARRS). While the ARRS has improved patient care, particularly in the area of medicine optimisation, it has been less good for communities where recruitment is difficult. Those areas were already underserved. Is the solution for PCNs to help their neighbours to fix this issue – a network of networks as mentioned in the PCN Network report? 

Where the workforce is in place there are challenges with space, training and management. The ARRS does not solve the GP shortfall. PCNs need the flexibility to employ who they want as they want, perhaps with part-time or temporary contracts. Larger PCNs, or PCNs in a federation seem to cope better, as outlined in our PCN profile of Tower Hamlets in east London. But again, inequalities have to be tackled by working closely with communities. The more remote provision gets, the less things will change. PCNs need the flexibility, support and resource to to achieve their potential and make a real impact. 

Victoria Vaughan is editor of Pulse PCN