Leading questions: PCN management expert Tara Humphrey

Tara Humphrey, CEO of THC primary care, which provides interim management training to PCN leaders and has supported more than 120 PCNs, speaks to editor Victoria Vaughan about the new contract and PCN network managers

Victoria Vaughan (VV): How did you first become involved in PCNs?

Tara Humphrey (TH): I started my involvement with PCNs in 2018, just before they went live in 2019. I was supporting a frailty project for Redbridge GP Federation in London.

I was a project manager coming in specifically to roll out a frailty list across 42 practices and shortly afterwards, conversations around primary care networks started taking place with a focus on the network agreement.

I think the assumption was, which is so funny now, that if the network agreement is in place, it would all be smooth sailing from there.

VV: What’s your current involvement with PCNs?

TH: For the last nine years, I’ve been the CEO of THC Primary Care. We provide interim management training and facilitation to PCN leaders.

I found myself in the right place at the right time and started to write about and share my experience, which then attracted other people to say ‘I like what you’re doing’ or ‘Can you help me? From network to network, it just started grow.

VV: What are the common problems for PCNs that don’t have dedicated managers?

TH: I think recruiting without a purpose can be a big issue and generally not having a vision or a mission. The networks without managers often lack structure and the required transparency to ensure that everything is being taken care of.

Regardless of how many practices are in your network it’s a huge ask for the clinical director or a practice manager to take on the responsibility for governance, financial and resource management, recruiting and HR to mention just a few.  

HR issues can be magnified without dedicated management support, and the network will experience blind spots as they won’t be plugged into PCN management networks and be able to learn from other networks’ experiences.  

But I know some networks that do not see the value in having a manager, and this approach does work for them, especially if their network is the practice and lines are really blurred.

VV: In the contract letter, it suggested that the clinical director payment and the management payment can be pooled. Is this a good idea?

TH: I think those who have a PCN management role understandably want to feel safe, secure, and protected by being included in the ARRS scheme and they will continue to be disappointed that their role is not formally recognised.

I know networks can move managers into the digital transformation lead (DTL) role, but there are different views on the DTL role. That’s okay because it’s not a one-size-fits-all solution.

For forward-thinking networks, pooling the budgets enables them to continue to organise them to best serve the network which is good for both managers, administrators and clinical directors. Many networks do this anyway. My initial view is that I do not think this will have an adverse effect.

VV: How does the relationship between successful clinical directors and their managers work?

TH: Trust is implicit. Communication is regular. The scope of both roles is clear. Managers have the authority to make decisions where appropriate and both parties are in service of the network, and the same applies to all roles in the network.

VV: What are clinical directors, who don’t have this kind of working relationship, missing out on?

TH: They will likely experience a duplication of effort, due to lack of trust, and poor employee morale because the manager is unclear of what is expected of them, a high turnover and a poorly functioning network which is stressful.

A GP knows what it feels like to have a superstar practice manager lead the day-to-day practice operations and what it’s like when another manager isn’t performing or leaves.

The primary care network manager role is the equivalent to this.

VV: Why are PCNs working well in some areas and not others?

TH: It works well when you’ve got integrated care board (ICB) support. When you’ve got a vision and direction around what makes sense for us to do together and what makes sense for us to keep at our practice level.

I also see that networks that have got a really good handle on their finances and are open to business opportunities are thinking innovatively and entrepreneurially.

And of course, when you trust each other, have good systems and processes and meet and communicate regularly, these are the ingredients for a really solid foundation.

VV: Do PCNs need more support?

TH: There is already the General practice improvement programme, you’ve got the Digital and Transformation Lead National Programme, there’s PCC which does lots, there’s people like me providing development. The NHS Confederation provide support.

Together with with eGPlearning and Ockham Health, we provide tailored leadership and management support in our PCN Plus programme and many ICBs have also commissioned development. There is much more out there.

Support is there, but networks need time to participate and engage with it.

VV: What’s the future for PCNs?

TH: When I read the letter, I thought the networks that are mature would say ‘thank you’, move on, and keep doing the stuff that they’re doing. Now they have got the kind of absolute permission to organise their resources in a way that they would want to and that will help them soar.

The middle pack may still consider this steppingstone contract too short-term to act. These networks will hold their position, for better or worse or neutral.

And then for the final cohort of PCNs, it could give them an opportunity to say, ‘Let’s just divvy it up by a list size, because there’s no accountability of really how the money needs to be spent apart from the clinical director saying, ‘We’ve met one or three of the requirements of modern general practice’.

Hopefully, I’m wrong, and the majority of networks will take the increased flexibility to invest in stabilising core general practice, which is underpinned by primary care network resources and collaboration.