How can PCNs support elective waiting list recovery?

Your initial response to this question may be ‘Why would we support a problem created within another sector of the healthcare system?’, but all of these patients are registered with one of our practices, they are on a waiting list because they have a health need and are often suffering in some way and most were referred by us initially.

Many are also requiring a lot of support from us while they wait. I say to patients, ‘I have referred for you because I am sure that I have done everything I can for you in the community and you now need tests or a skill set we cannot provide to you’. It is very disheartening as doctor not to be able to help a patient while they suffer.

Although we still lack the majority of the details of the upcoming contract, what is clear is that elective recovery will be a priority and the primary care part in that will be vital if any plan is to succeed.

 So, what might be included and what could we do if all options were explored?

Scale up plans in all pilots

What we aren’t great at in the NHS is scaling up and adoption of ideas piloted in one area and shown to be successful. Often successful ideas don’t even survive beyond the trial period in the areas they were set up.

The NHS needs a change in mindset. All new pilots or transformation projects need to include in their plan how their idea would be easily scaled up if successful. I don’t mean some bland case study in a paper, I mean meaningful toolkits with preset searches, step by step ‘how to’ guides, lessons learnt, data sets to measure, training webinars etc .

Nobody should be investing NHS money without considering how to achieve this and it should be routine practice. I was lucky enough to attend an awards event this year and hear about hundreds of amazing projects that had changed patient lives, most of which will never leave the boundary of that service or area. What a shame!

A new culture

We need a new brave culture of being able to try things and give things a go. Everyone from ICB chairs to front line clinicians need to be empowered to push for transformation and potentially beneficial new models of care.

Let’s stop protecting our empire and work together for the good of the NHS and the patient. If we need to develop a new community clinic or work differently on estates lets have the conversation.

Protect funding

Consequently, ICBs and NHS England also need to stop seeing the funding that allows us to innovate as easy picking for deficits elsewhere in the system. A number of PCNs, including my own, saw their system development funding slashed this year to plug the secondary care deficit issue.

Health inequalities funding has been directed to cliff edge projects. Therefore it’s not reaching the teams who could actually be doing this work and progress is being stalled and discouraged. Those with enthusiasm are losing their goodwill.

Fund integrated neighbourhood teams

Integrated neighbourhood team working could be vital to keeping patients well and better cared for. It has been mentioned for a number of years now by NHS England as a priority, but many areas have no or little plans, there is a lack of leadership investment in coordination in its set up and no funding at all to PCNs or practices to support the input required. Is it really a priority to NHSE if it isn’t invested in?

Review advice and guidance

But what about the responsibility of secondary care here? We have heard lot about advice and guidance recently. Is anyone thematically reviewing the common advice and guidance submissions across each speciality? These should be used to prioritise areas for training, new NICE guidance or national areas of training focus. There must be a topmost common asked question for each speciality.

I would encourage all secondary care colleagues to take up the opportunity to work with PCNs, be brave, look at new models as this what is best for the patient. Take responsibility for inefficiencies and look at how you can improve productivity. Are we doing the right work?

Finally, we need to put the patient back into the middle of the plan. A model is useless if there are so many potential gaps where a patient could fall through the net and be lost to follow up, or a significant diagnosis missed. Let’s not forget their needs and safety in the drive to bring down waiting lists and make the numbers look better.

Dr Laura Mount is clinical director of Central and West Warrington PCN, Cheshire, and a member of the Pulse PCN Editorial Board.