A group of PCN leaders from around the country joined our first roundtable event for an open and honest discussion about their PCN journeys. Held on 25 March, the online event enabled leaders to share valuable feedback and insight with their peers.
The session involved a mix of Clinical Directors and PCN Managers, who shared insightful perspectives. All PCNs face their own challenges, depending on location, local needs and pressures, and resources. Although each network is at a different stage, common themes resonated during this session. We outline the main topics, thoughts and experiences shared on the day to provide useful knowledge for other PCNs. They can see how their experience compares and take reassurance that others are facing the same issues.
How has Covid-19 affected PCN journeys
It is no surprise that COVID-19 has caused major disruption to the way the NHS operates. With the drive for fewer face-to-face interactions, to protect the safety of patients as well as staff, it has been a challenge to coordinate care while navigating the new COVID-19 world.
The pandemic has required innovative ways to work, especially given its unpredictable nature. Networks initiated additional meetings and check-ins to ensure that everyone understood the latest guidance and could coordinate effectively. Practices shared resources, particularly in delivery of vaccination programmes, to ensure patients received the best care.
Learning from this experience some leads suggested that this connected way of working could be a blueprint for other healthcare programmes. The pandemic forced networks to work more closely together as everyone needed to accelerate at a similar rate and implement new working methods.
Sharing knowledge and expertise between practices has been key to finding innovative solutions for care, having identified problems, offering extra support where needed. Continuing to build on the new relationships and approaches formed during the pandemic is an opportunity not to be missed to improve future health and care strategies.
How to approach PCN leadership
There was a consensus amongst our leads that it is common for the ‘usual’ colleagues to volunteer their time to support the PCN. They agreed that while it is good practice to play to individual skillsets and strengths, systems need to be in place to ensure a sustainable model is implemented in which people are not overstretched. The effort contributed needs to be proportional to the amount of positive change being made.
Different approaches were adopted on the role of PCN managers. Some of the larger PCNs have full-time PCN managers to take on responsibilities that would otherwise fall to the PCN’s Clinical Director who simply do not have the capacity. Others had a part-time role, sometimes across more than one PCN. The management role within PCNs should not be underestimated; the benefits are not limited to liberating the clinical lead from more transactional tasks and enabling a leadership approach but the development of shared leadership functions across both roles.
Concern was voiced around how PCN leaders will be able to influence the development of system approaches through ICSs. The challenges facing PCNs include not only how the representation of PCNs will be managed (will all PCN Clinical Leads have an equal voice and a seat at the leadership table) but also where the funding and capacity for active involvement will come from.
How to cope with continuing pressures and support wellbeing
The increasingly pressurised environment for health and care workers was an existing issue, heightened further by the pandemic. The PCN leads in our discussion were very aware of the impact on an overworked and exhausted clinical and non-clinical workforce with everyone juggling COVID-19 while ensuring that non-Covid issues are addressed too.
They understood that although difficult it is important to create time and to focus on PCN developments. This is needed while also ensuring that each colleague has the capacity to complete their normal work and provide the highest standard of care.
The PCN leads reported that over the last year there had been more wellbeing check-ins with staff as the pressure of the pandemic mounted and workload increased. Investing time in sessions where all practice roles (both clinical and non-clinical roles) are represented ensures consistency of messages and provides the opportunity for collective solutions to be identified. Whichever the approach, regularly evaluating each person’s role and wellbeing, within the PCN helps to align responsibilities and spot any gaps that might benefit from additional resources.
Alongside this, the inclusion of digital solutions continues to assist in the transformation of care to benefit staff and patients. Participants saw how technologies such as online meetings and virtual consultations, had been used during the pandemic to help ease some day-to-day pressures. They agreed that these digital developments will continue to help alleviate pressures within the NHS in the future, but that it may take some time to fully feel the effect.
How to ensure continuous development
Our PCN leads outlined one major factor that can positively or negatively contribute to a PCN’s success: collaboration. They highlighted that coalescing around a shared vision for the PCN is fundamental to having a functional network, especially in larger PCNs where multiple practices are involved. The existence of a shared attitude was felt to be of equal importance in ensuring collaborative solutions to challenges.
All participants felt that moving forward, it is important to periodically review the PCN’s vision. This ensures it is moving in a positive and inclusive direction and enables adjustments as necessary, based on feedback within the network.
Although each practice will have its own local needs and policies, it’s important to look for ways to create common ground for the PCN. One of the ways some have achieved this is by standardising policies, pathways, systems, and processes. Sharing and learning from best practice can streamline administration tasks, so focus can be shifted elsewhere. It also gives one cohesive voice to the PCN and allows it to build on commonalities and shared frameworks, ensuring everyone feels part of one team. The application of a consistent approach across member practices when applied to the on-boarding of additional PCN roles ensures that new team members feel a sense of belonging to the PCN regardless of the location from which services are provided.
At the end of the roundtable, all PCN leads felt reassured that they share similar struggles and were able to view their journeys with some new perspective. The success of a PCN is down to its individual parts; it is up to everyone to identify problems, voice opinions and create a community. Building a safe and supportive environment begins to solve some of the major obstacles facing a Primary Care Network.
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Read more from Alison Westmacott.