Opinion: PCN clinical directors are not an NHS policing service

Dr Geetha Chandrasekaran clinical director, North Halifax PCN, West Yorkshire, shares her thoughts on the recent contract announcements and the expectations it places on network leaders

Another year and… finally a letter outlining a contract for 2024/25. Working for years as a GP I am no longer surprised by late announcements of contracts, nor do I expect too much from them. I am less disappointed this way and protect my mental wellbeing.

Overall, it’s less than satisfactory for General Practice but I will focus on PCNs.

Considering the uncertainty around the viability of PCNs’ I don’t think it is all bad news. The protection of the additional role reimbursement scheme (ARRS) has been promised for a while but the extension in a format that is familiar to us with ongoing infrastructure, clinical director (CD) and leadership payments is welcome.

Many PCNs including ours have invested time, people and money into making PCNs work for their populations. They have achieved great things, grown new services and learnt to work collaboratively for the health and wellbeing of their populations and it would have been a shame to lose all this.

Having an overarching set of principles rather than eight separate indicators may help PCNs to invest in areas that would be beneficial to their individual populations allowing for a more holistic approach depending on demographics and using population health data.

The 70% unconditional capacity and access (CAP) funding remains a very positive aspect of the DES.

However, it is not all good news.  

On the 2% increase, the less said the better, and it doesn’t actually mention if this will be available to PCNs.

Expanding ARRS roles on the face of it seems a good thing but we were all told to spend our entire budgets last year or risk losing it. So that’s what we did. Now with no increase in overall budgets we have no scope to engage new staff and roles. So, while on the face of it, it’s a helpful change, it’s not one we can take advantage of.

Reducing the impact and investment fund (IIF) indicators and putting the money into CAP does not reduce bureaucracy. It is merely moving pots of funding around. And, of course, the indicators we achieved are removed and the controversial ones remain.

The three elements required to get the remaining 30% of CAP funding is dependent on individual practices complying and the letter has it that the responsibility of assuring this to the ICB is falling on CDs. As we know, practices are independent contractors running individual business models that suit their patients within the GMS contractual regulations. Putting CDs at the centre of this is unfair and could actually cause PCNs to start doubting what the future will hold and could disrupt both the great services that have been set up and the trust that has been built.

In my PCN we all work well together, but who am I to say a practice has to fund callbacks or have online consultations during all core hours, especially if there is no guarantee of recurrent CAP funding. And how, as a CD do I become responsible for these elements that are to be provided at practice level. I am neither a commissioner nor the NHS policing service and never became a CD to be either.

I will be focussing on keeping established services running seamlessly, allowing growth and development within the team, channelling an emphasis on proactive work to help our population and cementing collaborative working through our wellbeing partnership. This is our version of a neighbourhood team, way before Fuller and even PCNs.

While I acknowledge there are tricky times ahead, I remain optimistic as my lovely PCN team and practices, who do their best everyday for our population, continue to inspire me to carry on with a smile. 

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.