By David Mphanza, Senior Consultant, NECS Yorkshire Consultancy Team
GPs are by far the largest branch of British medicine. A growing and ageing population, with complex multiple health conditions, means that personal and population-orientated primary care is central to any country’s health system. As a recent British Medical Journal headline put it – “if general practice fails, the whole NHS fails”1.
This was the opening paragraph by Simon Stevens in the General Practice Forward View, one of the key publications released since he became Chief Executive of NHS England. This publication focused on his vision of a transformed primary care and since its release General Practice has been on a journey, with a significant milestone being achieved in the form of the Network Contract Direct Enhanced Service2 (DES) which is also referred to as the Primary Care Network (PCN) DES.
Practices collaborating and working in innovative ways isn’t a new concept. If we look at the last few years there have been various iterations such as Primary Care Homes, Multi-specialty Community Providers (MCPs) and Primary And Acute Care Systems (PACS). What stands PCNs apart is the contractual structure which has been used to provide financial incentives. Previous DES specifications focused on individual practice attainment to receive remuneration, now practices are required to work collaboratively in order to fulfil the contract specification and receive remuneration.
NHSEngland / Innovation have shared how they envisage PCNs maturing through the release of the Maturity Matrix, providing sequential aspirations to ensure not only continuous development but also encouraging GPs to collaborate further with Primary Care colleagues.
In the NHSE/I Midlands region NECS Consultancy is providing support to this team through our Midlands Enabling Programme, the crux of which is Subject Matter Experts (SME) within the areas of Access, PCNs and Workforce. Working in this paradigm allows these SMEs to identify best practice within the region and begin to connect PCNs, CCGs and STPs together to share this learning, to support the development of a robust, resilient system with a culture of networking and collaboration. Thus allowing PCNs and local systems to identify models which will work effectively for their population enhancing the patient experience and journey. In doing so PCNs will be able to fulfil the DES specification and it may also provide opportunities to benefit from economies of scale, further releasing resource to allow for innovative ways of working.
If anyone ten years ago had said: “Here’s what the NHS should now do – cut the share of funding for primary care and grow the number of hospital specialists three times faster than GPs”, they’d have been laughed out of court. But looking back over a decade, that’s exactly what’s happened1.
So what happens next? PCNs are being directed to collaborate further with Community Providers as they mature as health systems, which can provide an opportunity in how Out of Hospital services are commissioned as well as provided within a health economy system. The emergence of Integrated Care Systems (ICS) also provides a parallel opportunity to support the sustainability and success of PCNs; the maturity of ICSs is further explored by NECS in this blog: Maturity Matrices as a Tool to Deliver True System Transformation
To conclude the development of the PCN DES marks a significant milestone in Primary Care transformation and in achieving the vision set out in the GPFV. A key enabler being the restructuring of financial remuneration for GPs, it stands to reason if there is further transformation of financial incentives within the NHS and the wider health care economy it could provide a continuous catalyst in the delivery of integrated services, resulting in an enhanced patient experience.
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- NHS England. 2016. General Practice Forward View. [Accessed 20 October 2019]. Available from URL: https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf
- NHS England. 2019. Network Contract Directed Enhanced Service (DES) Specification 2019/20. [Accessed 20 October 2019]. Available from URL: https://www.england.nhs.uk/publication/networkcontract-directed-enhanced-service-des-specification-2019-20/
- NHS England & NHS Improvement. 2019. Primary Care Network Maturity Matrix. [Accessed 20 October 2019]. Available from URL: https://www.healthylondon.org/wpcontent/uploads/2018/10/PCN_Maturity_matrix_19_20_Final.01.pdf