PCNs should prioritise hard-to-reach patients

PCN leaders were encouraged to think about tackling health inequalities for people experiencing multiple risk factors at the latest Pulse PCN London event.

Dr Agatha Nortley-Meshe, London regional medical director for primary care, NHS England, discussed health inequalities from a system perspective, highlighting that if PCNs can get to the hard-to-reach patients it will benefit all other patients.

‘When we talk about access, we tend to talk about making it easier for the people who are trying to contact us, to contact us, which is great. We’re doing all of that. However, what are we doing about people who don’t contact us, who can’t contact us, who can’t get in, who can’t register, who aren’t aware of what services are available, who we call ‘hard-to-reach’, but are we really trying to reach them?’ Dr Nortley-Meshe said, highlighting recent work with the Philippines where they are developing a universal primary care offer, particularly for remote populations.

‘The ethos behind what they were saying [in the Philippines] was, if we can get to [remote populations], everyone else will fall in. And I think there’s something about how we then describe our approach to health inequalities here, because I don’t think we’ve said that yet. I think we’re trying, and it’s very much at the top of the agenda. And we’ll see all the things that are happening regionally and nationally, to say, we need to focus on health inequalities, but if we can get to those that have become hard-to-reach, the ones we’re really struggling with, those who are most vulnerable, most complex, if we can get them good care, it will still be better for everybody and everybody else who we think we’re trying to help, will benefit. So why don’t we do that instead?’ she said.

Dr Nortley-Meshe challenged PCNs to look at intersectionality of inequalities across geography, inclusion health groups, deprivation and protected characteristics and focus on patients affected by several of these, who need a higher level of support.

‘If you’re in those groups where it’s difficult for you to access care, maybe financially you’re really struggling, you live in an area where you don’t have access to the same services. And we’re saying, ‘Oh, they didn’t turn up for their appointment’. So, the hospital discharges them, or [people say] ‘they didn’t engage with services’. Of course, they’re not going to engage with services, if they can’t afford the bus fare to get to the appointment, they can’t afford their phone to ring us. Their priority is keeping a roof over their head and feeding themselves. So we’ve got to work wider than healthcare, with social care with local authorities with the voluntary sector. This is not a primary care problem. It’s a whole system problem,’ she said.

Also at the event, Dr Emma Tiffin, GP advisor for community and primary care adult mental health for NHS England, spoke on how they created a more integrated mental health team in Cambridgeshire and Peterborough.

‘The vision was very much around bringing together the clinical side with community support, and engaging the whole system so that we all own our mental health model,’ she said. ‘We moved from isolated silos towards things that wrap around a person.’

In a session on AI pilots in London, Dr Shanker Vijayadeva, GP lead – digital transformation (primary care) for London region, NHS England, shared about the value, challenges and some of the learnings from pilots that automated patient registrations, call and recall functions and pathology.

This learning included that PCNs should try to adopt digital tools ‘off the shelf’ rather than commissioning bespoke services, as ‘off the shelf’ services are typically more cost effective and commercially viable, therefore the tool is likely to be more sustainable.

‘The market has gone more towards off the shelf, so you don’t work with the provider to get a bespoke solution and then find that they’re exiting the marketplace and they can’t support it anymore,’ said Dr Vijayadeva. ‘We definitely had some of those experiences in the pilot.’

When questioned about the source of funding for AI tools, he said if they save time, such as automating patient registrations or call and recall functions, that funding could come out of PCN’s workforce budgets.

‘We know core GP IT is meant to be funded by your ICB and NHS England but when we look at the funding stream, it just doesn’t cover your core GP IT – your hardware,’ he said.

‘So, you have all these other [digital] products and where do we find the money? Firstly, be sympathetic to your ICB. There are people who are having conversations about can there be additional funding streams.

‘But when you break it down, a lot of this is surely – as a practice – budgeted against your workforce bill. You would hope this would stack up based on staff time.’

Also at the Pulse PCN event, held on Wednesday, Dr Mark Remedios, clinical director (CD) for Feltham and Bedfont PCN in Hounslow discussed the challenges of bringing PCN practices together and Dr Jeremy Carter, CD at Herne Bay PCN, Kent covered the latest GP contract and Network DES.

He highlighted that there is now a duty on CDs to ensure practices are operating the Modern General Practice Access Model and to inform the commissioner of PCN delivery against the local capacity and access improvement payment (CAIP) criteria.

Pulse PCN Events will be heading to Manchester and Newcastle as well as returning to London later in the year. To register for your nearest event, click here.