Not Another View on PCNs

Just finished reading the BMA Primary Care Network (PCN) Handbook and it was worth it.

You can read it here.

I am impressed!

The ambitions are brave, advanced and a step in the right direction.

It is all about services and workforce.

It is not immediately obvious, but the same underlying principle has driven acute hospital reconfiguration programmes in recent years, I take the example A&E and maternity unit closures in south west London.

To illustrate (with some simplification); 5x A&E’s and 5x maternity units in close proximity to one another led to a strong ‘case for change’ for unit closures. Driven not only by the financial challenge, but by an even more pressing workforce crisis. Not enough A&E doctors which no amount of money can affect ie. staff cannot materialise out of thin air. Trusts have been battling with rota’s and vacancies. For. Years.

Cue, ward or department closure at say 2/ 5 hospitals and bam! Workforce disaster averted. At least for now.

Ensuring fully staffed rota’s 24/7 becomes less of a headache. Specialist services are centralised and quality care ensured through critical mass and retention of highly specialised skill-sets. However politics got in the way and it went down like a lead balloon.

So back to primary care.

PCN’s will deliver services together and share an ‘expanded’ workforce. Interesting.

Like A&E doctors, it takes 10 years to ‘make’ a GP and the workforce is diminishing. A diverse workforce; less reliance on GPs and more diversification (who are quicker to train and get) is the solution. In other words, an ‘expanded workforce’.

Finally, a step in the right direction with NHSE agreeing to fund some primary care staff. The incentives are correctly aligned with the prioritisation of salary support for social prescribers, primary care pharmacists, primary care paramedics, first contact practitioners and physician associates. HEE fully aligned having already been working on developing this ‘new’ workforce over the last few years.

For patients, it should be comprehensive service delivery at a 30-50,000 population level.

It all makes sense- at least for now.

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