Leading questions: Dr Laura Mount

Dr Laura Mount, clinical director for Central and West Warrington PCN and newly appointed editorial board member for Pulse PCN, reflects on her time running a PCN and looks to the next year of the Network DES with senior reporter Jess Hacker.

Looking at the next 12 months, what are you most concerned about for PCNs?

The main concern is what happens after the 31 March next year. While it is really challenging to coordinate and run a PCN, manage staff, manage budgets, it’s even harder not knowing what any of this will look like past that day. We are having to make decisions without certainty on targets and funding.

A big question mark is around our staff: we’ve had statements that ARRS will carry on but we haven’t got any indicative budgets or rules or even if there will be any changes. Nothing more than a vague statement saying we should put them on permanent contracts.

Another uncertainty is that our contracts and the Investment and Improvement Fund (IIF). The IIF changes every year – often with a month’s notice – but it’s also recently changed in-year too. That is just completely impossible to plan for: you train people, set up services, educate patients and then the plan has to change. A lot is asked of us for quite little resource.

What do you say to the argument that PCN money should be pulled into the core contract?

I get that opinion. That was definitely the majority of people’s opinion initially. All PCNs are unique and I think a lot of people who hold that opinion are in a PCN which might have a different dynamic to mine. We have an incredibly supportive group of six practices. We don’t always agree but we come to a common consensus because we’ve built up trust from experience. That’s where we’ve found the benefit and if you’re in a PCN that hasn’t got a good manager or without anyone to take on the director role then that must be really hard.

That will be especially challenging if the practices are picking up the burden of the work. In our PCN we try to use the resources we have in a way that relieves practices of pressure. For example, our practice did all housebound Covid vaccinations and flu vaccinations so that our other practices’ could free up their nurses, and we trained our staff to deliver blood pressure identification clinics for a similar reason. The aim in a PCN should be to make sure practices feel like they’re having work being taken away from them rather than added.

Why did you take on running the PCN? Has working in a PCN turned out the way you thought it would?

I became a clinical director right at the start of the pandemic, just as there was a big transformation within our PCN. Being a clinical director is a role that requires an understanding of commissioning and providing primary care so it’s not something that everyone feels confident to do and there wasn’t anyone in our PCN who felt that confidence. I took it on as a temporary position, with a view of doing it for about six months, to get us through that stage.

It wasn’t something I particularly wanted to do at the beginning, although I did come to love it. There’s room to make a difference and influence what you do for patients. We have clinical governance processes and quality committees but we don’t have to spend a year waiting for permissions to do something, because we can just do a proof of concept, try it out and carry it on or learn from it. We did that a lot with the [Covid] vaccine programme. We’ve just done it again for a big project for people who are reluctant to have their smears – we got about 220 of those people in by offering a counselling service as part of the clinic.

I knew [taking on the role] would be challenging but some of the changes we’ve seen [over the years] have been much bigger than I expected. The toughest point was this last winter – we felt really very forgotten in primary care. There was very little support and we were very much left to get on with things ourselves: that was made harder by the fact staff were coming out of two pandemic years. We had to cope and we felt very cut off.

What could NHS England or Integrated Care Boards (ICBs) do to help prevent primary care from being side lined?

Give us certainty on the core work we’re expected to do at least one years in advance. In terms of Covid recovery, primary care was not considered and we were working with a contract that had been negotiated pre-pandemic: that wasn’t fit for purpose, especially as costs for practices were spiralling. They need to listen to staff on the frontline and actually consider what they say would bring meaningful change for patients, rather than chasing headlines.