PCN leaders fear loss of local support with demise of NHS England

PCN clinical directors have shared their concerns over losing ‘good local support’ in both ICBs and NHS England, following the news of cuts to the healthcare system.

This morning, the Department of Health and Social Care (DHSC) revealed that NHS England would be abolished with functions brought back into the DHSC to ‘end duplication’ across the two.

The health secretary said they ‘can’t justify such a complex bureaucracy with two organisations doing the same jobs. We need more doers, and fewer checkers, which is why I’m devolving resources and responsibilities to the NHS frontline’.

Also today, it was revealed that ICBs would be tasked with cutting their workforce by around 50%, which equates to 12,500 across the system.

Speaking to the House of Commons Public Accounts Committee (PAC) this morning, Mr Kelly said this number is administrators that are not providing frontline services.

Dr Geetha Chandrasekaran clinical director, North Halifax PCN, West Yorkshire, said that the shake up ‘may well push the integrated neighbourhood teams agenda’, but that their PCN has ‘good local ICB support’ and she is concerned this will be lost, as well as the ability to push local needs.

Dr Laura Mount, clinical director of Central and West Warrington PCN, Cheshire, added: ‘I feel for my colleagues in the ICB and NHSE. Most of them work incredibly hard to ensure that patients receive good quality, safe services. 

‘My fear is that we will now see an exodus of the best of the NHSE as staff worry about job certainty and so find other roles.’

She added concern that workload would be passed onto PCNs and general practice.

‘I hope that this process is managed well and considerately considering the impact upon staff and patients,’ she said.

Clinical director at Enfield Unity PCN, Dr Sarit Ghosh, said there will be a ‘gap that I think will have to be filled by PCNs and at scale providers’.

‘A broader more ideological concern I have is the loss of separation of the healthcare arm of government (NHS England) and the policy and political arm (DHSC). I think we will see politics increasingly define the future of the NHS and this may lead to short-terminism and great disruption when new governments come into power,’ he added.

Dr Sajid Nazir, clinical director at Viaduct PCN, West Yorkshire, said he had ‘different perspectives’ on the news, with on the one hand increasing efficiency and accountability and reducing waste being ‘welcome news’.

But on the other, he believes it could have a ‘detrimental impact on primary care’.

‘Examples of this would be administrative workload shift or delayed payments. I am also concerned that ICB’s may cut down the clinicians employed by them, which would reduce our leadership and clinical representation,’ he said.

‘Finally, there are many experienced and skilful staff who may lose their jobs and this is a very difficult time for them.’

Though Dr Jeremy Carter, clinical director at Herne Bay PCN, said it was ‘hard to say’ what would happen now amid ‘uncertainty’.

He added: ‘We have staff working under an uncertain environment which is never healthy, and I would imagine at least during any transition, a negative impact on service delivery/improvement, just because time will be taken in the process of organisational change.’

However, he said that a lot of this was speculation and ‘what ifs’, and that PCNs ‘will stand ready to continue to strive to deliver the best care for our patients in whatever framework comes from this’.

Professor Aruna Garcea, chair of the NHS Confederation’s primary care network added: ‘Our members will understand the dynamics at play here, but it comes at an extremely challenging time, with rising demand for care, constrained funding and the need to transform services.

‘History tells us this will cause disruption while the transition is taking place. Much of the focus will need to go on stabilising the NHS in the short term to prioritise patient care but we also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming ten-year plan. Primary care leaders will, as always, remain focused on delivering good care for their patients in the context of the wider environment.’

It comes after NHS England served up insight on 12 best practice neighbourhood healthcare examples last week, three of which included PCNs.