How to take a strategic approach to PCN additional roles

Let’s be clear – general practice is the bedrock upon which our NHS healthcare model is built. But, as with anything, there are opportunities to continuously evolve and improve. PCNs are a good example of this – a recognition that there is value to be gained by working collaboratively across geographies and maintaining a local community focus.

In principle, the concept of PCNs receiving additional funding to diversify and augment their teams is transformative, enabling multidisciplinary teams (MDTs) to be formed around population need. Additional roles enhance the capacity of general practice, addressing increasing demand through the development of a broader range of services, tackling access challenges, improving patient outcomes and freeing up GP time to concentrate on the highest complexity work where they are needed most. But there are challenges. Impending increases in national insurance contributions and uncertainty about future funding arrangements present potential risks for those employing additional roles, while inconsistent deployment of these roles limits their impact.

With a renewed focus on out of hospital care and a move towards neighbourhood health, PCNs need to draw on data to maximise their impact on patient outcomes and strengthen general practice.

Data-driven workforce

Key to making an impact through the additional roles is the use of data and intelligence around the existing and future needs of the local population in relation to the current workforce in primary care and beyond. Analysing patient data to understand and benchmark local priorities provides opportunities to consider new approaches to care and inform workforce planning at a neighbourhood level using funded additional roles.

For example, if the data indicates that the prevalence of diabetes is high across a PCN geography and lower limb amputations are also higher than expected when benchmarked with similar geographies, could the employment of a podiatrist focussing on this cohort make an impact?

If the Joint Strategic Needs Assessment (JSNA) data indicates that air quality is predicted to worsen in a geography, would the development of a proactive respiratory team support the population and prevent hospitalisation?  Could ARRS funded team members lead collaborative working with the local authority and local communities to identify approaches to improve air quality and / or mitigate the impact on local people?

How could enhanced access sessions be designed to address the needs of specific cohorts of patients, providing targeted multidisciplinary clinics meeting the needs of the population and attracting clinicians to run them?

We’re seeing PCNs use these and other data-led insights to assess how additional roles can best support their patient population, putting proactive care pathways in place to reduce the risk of worsening health and unplanned hospital admissions. Data insights are also giving PCNs the confidence to reassess the initial commonplace approach of recruiting roles with which they are most familiar and whose outputs are easy to track and evidence. By aligning their ARRS workforce more closely to patient needs, PCNs can use data to monitor improvements in patient access and outcomes and adjust care pathways accordingly.

Neighbourhood health

While the recently published ‘Neighbourhood health guidelines’ recognise the need for integration of services at a neighbourhood level, there is no explicit reference to the role of PCNs. Where integrated neighbourhood teams (INTs) have emerged or are being developed this is largely around a PCN or group of PCNs supporting a neighbourhood level population – at this level the additionally funded PCN roles can make a significant impact.

While there is an argument for allocating ARRS funding across individual practices in a PCN enabling each to recruit the roles they need for their patients, particularly in rural geographies where it is difficult for patients to travel for healthcare, the starting point for neighbourhood health already exists where PCNs are operating PCN-wide clinics or a hub and spoke model to reach into local communities.

To avoid being overlooked, PCNs need to be on the front foot, sharing compelling examples of collaboration and innovation led by and through general practice to become the conduit, if not the catalyst, of successful implementation of neighbourhood health.

Reality check

If this is deemed aspirational then the context in which we need to consider the ARRS roles is a little starker.

• The ability of PCNs to adopt a truly data-driven workforce approach varies considerably. Some have developed sophisticated population health management capabilities, while others are less digitally mature and even accessing the right data can be a significant hurdle.
• The need for more GPs is tangible in general practice. With the ratio of patients to GPs – 2,292 patients per GP FTE in 2024 – still falling short of recommendations made by thinktanks and professional bodies, the extra ringfenced ARRS funding specifically for GPs is welcome but unlikely to make a material impact on addressing the challenge.
• MDT working requires cultural and operational shifts, including well-defined referral pathways, robust clinical supervision and clear role expectations. Training, leadership development and structured team building is key, alongside clear communication and consistent implementation of roles to avoid patients feeling confused about who to see.
• The primary care estate has been creaking at the seams for years. PCNs can only expand their workforce if they have suitable space for these additional patient facing roles.
• Changes in local and discretionary funding are hitting hard in some areas and risk destabilising practices. This, coupled with the increase in employer costs and the lack of longer-term certainty of ARRS role funding, means PCNs may opt not to increase any perceived financial risk.

These realities are not within a PCN’s scope to change in isolation. But PCNs can be part of the solution. Through focussed, strategic approaches to MDT working, upskilling where needed to enable better use of data to inform workforce planning, and integrated delivery of care, PCNs can continue to lay the groundwork for neighbourhood health and more sustainable general practice.

By Alison Westmacott, director of primary care, NHS South, Central and West Commissioning Support Unit