PCNs insulate us so we can deliver care

Dr Sian Stanley, CD for Stort Valley and Villages PCN in Hertfordshire and our new columnist, assesses the effectiveness of PCNs

When I signed up as my PCN’s clinical director (CD), I naively thought it would be a matter of gathering a team, recruiting a few staff through the additional roles reimbursement scheme (ARRS), then a pat on the back and a cup of tea.  

Instead it was more of a shot of espresso and a Crystal Maze of highly pressurised challenges. I feel like I’ve been standing in a wind tunnel for the past four years with information bombarding me at speed. Like being in the Crystal Dome trying to catch the gold tokens while avoiding the silver ones and wearing a very unflattering jumpsuit. The rules of the game changed, contracts were amended, the Investment and Impact fund (IIF) suddenly had different criteria. And then Covid hit. 

Suddenly it wasn’t like a game. People would die. I was in a leadership position I wasn’t trained for. The DES became a distant memory and we had to make everyone safe. As individual practices we had daily huddles to discuss our fears for our patients, our families and ourselves. We learned about Microsoft Teams, bought webcams, PPE, all manner of other kit, some of which we never used and some that saved lives. We turned each site into a different level of risk, one for the immunosuppressed and another for Covid patients.

Then we vaccinated. The start of that is still one of the best days of my life. 

I challenge anyone who saw the work we put into converting a football club into a vaccination centre to call it ‘money for old rope’. Our team worked night and day to get the vaccine rolled out and we did it efficiently and with great spirit. I know our experience was replicated by hundreds of PCNs and federations. I think primary care was never given the credit we deserved.

But I have never been clear whether I think PCNs are a good idea or not. Our PCN has made it work but these relationships did not form overnight. We are like a family – we wouldn’t necessarily choose each other and we don’t always agree but we do respect each other and can compromise and work as a team.

My fellow CDs in East and North Herts (ENH) and West Essex have also provided support that only those in the Crystal Dome can understand. ENH CD Association has created a safe space where we can share learning and represent each other’s views at the myriad of meetings we attend. This grouping of CDs is where some of the value of the PCN model lies. There has always been a disparate landscape of practices, all with different needs and ambitions. Through the CD Association we have created a backdrop where the differences are acknowledged but the similarities protect us.

Anyone in general practice is cognisant of the issues we have faced. Our PCN and federation have helped insulate us so we can deliver clinical care to our populations. We have used IIF money to bring in additional staff, create energy grants and build extra capacity over the winter.

I know not everyone approves of PCNs and I recognise the frustrations of practices who would rather see the ARRS money go into core funding. I understand how some groupings don’t work. I also acknowledge there has never been a formal pathway for becoming a CD, which has called into question our legitimacy. But after this crazy journey I know PCNs can work. With the right people, primary care at scale can be a force for good.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN,  East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire

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