Opinion: Investment and impact fund changes

Dr Geetha Chandrasekaran clinical director, North Halifax PCN, West Yorkshire, shares her thoughts on the changes to the investment and impact fund

My initial reaction to the investment and impact fund (IIF) was not a calm one.

Let’s start with the silver lining as I am a positive person. Additional roles reimbursement scheme (ARRS) roles are here to stay, we will be addressing health inequalities and the IIF funding will flow in monthly on the basis of approved access plans.

IIF is an incentive scheme and therefore I expected that there will be carrots and sticks. But what I cannot seem to find is the clinically relevant, good practice, safety initiatives.

We have built a robust PCN team, slowly but surely utilising the ARRS roles to fulfil the DES requirements and work on the IIF indicators that make the most impact. Like any other organisation we do balance the resources with the art of the possible too.

My initial feeling is therefore, that the rug has been pulled from beneath us. We have worked so hard to achieve indicators through the turmoil General Practice is in – keeping track of what we might have to do differently this year for better outcomes.

PCNs were to bring practices together, to work collaboratively while still maintaining individual, tried and trusted methods that work for their own registered patients. The IIF and imposed contract this year might well reverse this and all the hard work we have put in over the past four years with practices looking for their share of investment to be able to deliver targets.

We no longer have incentives for structured medication reviews (SMRs) or the focus on CVD prevention, no one cares how many inhalers we prescribe, personalised care plans have had a shelf life of a year and safety in prescribing can take a back seat because all that matters is ACCESS.

The sense of achievement from helping these cohorts, from seeing the resources make an impact, has been all but meaningless. Obviously, the point is we carry on with all this good practice while chasing access. The IIF funds estates, new services, supervision, training, stationary, phone contracts and much more as the PCN infrastructure funding won’t stretch that far.

Despite struggling with a dwindling workforce, general practice still delivers more appointments now compared to pre pandemic levels. But the majority of the IIF has been repurposed to improve the already improved access. There is no magic workforce waiting in the wings so I wonder how this makes sense?

What troubles me most is what this does for patient care and staff morale.

General practice, including PCNs, are resilient. However, the pressure on both to deliver is relentless. What is an additional incentivised target one year, is snuck into the contract the next. When will we actually be valued for the services and care we offer and stop being pushed by senseless targets and swiped at by the media?

We will await further negotiations but in the meantime we can do this – triage more, signpost more and make sure the wider systems work harder too. We will continue to deliver as, for us as a PCN, what matters most is patient care.

I can now hand on heart say ‘I have given advice’ and go home on time … I just can’t say ‘call back tomorrow’.

Dr Geetha Chandrasekaran is a GP partner at Plane Trees Group Practice, clinical director of North Halifax PCN in West Yorkshire and on the Pulse PCN editorial advisory board.