Exit interview with a PCN clinical director

As Dr Kieran Gilmartin steps down as clinical director of Fareham and Portchester PCN, he tells editor Victoria Vaughan about his highs and lows in the role over the past five years.

How do you feel when you look back on five years as a PCN clinical director?

When I first took on the role in April 2019 as the clinical director for our PCN, there were not many volunteers who wanted to do it and go into the unknown world that was forced upon us.

Being a clinical director for my PCN has been an honour but it has also been one of the most challenging roles I have ever done – and that’s saying something, considering I have served in war zones, including Afghanistan.

The concept of PCNs was, as always, badly thought through. It was rushed and forced on us like everything from NHS England seems to have been over the last five or six years. It has been a roller coaster ride of emotions that has included way too much frustration at the direction primary care was being pushed into by NHS England and the new integrated care systems (ICSs) formed from the previous clinical commissioning groups (CCGs).

What went well during your time in the role?

It has got to be what we have built as a PCN in Fareham & Portchester. We have gone from nothing – like all PCNs across the country – to forming our PCN as a limited company with over 35 staff including a management team, administration, clinical pharmacists, pharmacy technicians, paramedics, nurses and nurse practitioners, social prescribers, MSK practitioners, GP assistants and care-co-ordinators.

The services provided by all these staff have helped immensely, considering the substantial increase in primary care workload over this five-year period. Without them, we would not be able to provide our services to nearly 47,000 patients from four practices.

Covid was an unbelievably challenging period for everyone, but the continued expansion of the PCN team showed the drive and determination of all involved and has led to the PCN being a stand-alone entity which is there to support the practices. Communication has always been the key to this success, and it has not been plain sailing. There have been lots of ups and downs, but by working through this together, we have achieved so much.

What were the biggest challenges?

I would have to say the biggest challenges have been the mandated and pointless targets from the PCN contract put together by NHS England. The lack of increased funding year on year in the PCN contract has also been difficult. It is ludicrous that the only components to be increased were the ARRS and IIF.

In a time when inflation and cost of living have impacted everyone, primary care has basically received little or no increase in funding and has been hit by massively inflationary costs.   

What do you predict for the future of PCNs?

Honestly, I wish I knew what’s next for PCNs. What they can actually provide seems so limited and I am not sure those at the top understand what is needed. The lack of funding is a driving force behind all of this. The constant theme is that we must do more for less.

The simple way to save primary care is to stop treating us the way we’ve been treated for far too long. Increase our funding properly and give us the time to recruit staff to provide the service we know we need for patients to receive the right care at the right time and by the right person.

The focus needs to be on improving care provision at the start of the patient journey and not on admission avoidance projects. Primary care has always been the best value for money – but we now need proper funding and time to make this work.

Otherwise, I do not see us existing. Not if it continues being funded and directed in the way it is by both NHS England and ICSs.

What needs to happen to better support PCNs and primary care?

The call is clear – they must listen to the needs of primary care leaders on the ground and prioritise their requirements over the continued erosion of services and staff. It’s time for a paradigm shift – one that allocates adequate resources to primary care as the foundation of the NHS rather than perpetuating the status quo. We have now seen that NHS England and the Department of Health are not listening to us on the ground with the 24/25 GP contract letter. This again shows they truly do not care for primary care and certainly do not value it at all.

The Hampshire and Isle of Wight ICS joint forward plan highlights the importance of spending more on preventative care, but actions must align with words. Until there is a change in the percentage of funding directed to primary care, a grip on the overall budget will remain elusive.