Chief Executive’s blog: June 2019

Chief Executive’s blog: June 2019

The challenge of PCNs: “It will be uncomfortable for some, but it’s not impossible”

By PSNC Chief Executive Simon Dukes

In his speech to the NPA Conference in Manchester last month, Ed Waller, who is Director of Primary Care Strategy at NHS England and NHS Improvement, said: “The idea of a Primary Care Network is not that people compete with each other … in some places this is going to be uncomfortable.” On 1st July 2019, 1,259 Primary Care Networks (PCNs) became operational across England, which could mean a lot of discomfort if the aim is for us all to leave behind competition within them.

For community pharmacies the first challenge must be to understand and accept that PCNs are here to stay. The good news is that they should also in the future be a source of potential funding for some services that community pharmacies can provide. To tap into this, we need to start to identify ways that we – as a sector – can work together more and, in turn, engage and work in partnership with other healthcare providers in our local PCNs. What does this mean in practice?

PSNC has provided a useful guidance document, but essentially it means in the first instance knowing which other community pharmacies are in your PCN and getting together with them – ideally with a member of your LPC present. You’ll need to identify what your collective community pharmacy coverage looks like: some things like patient numbers and what services you already offer, down to how many consulting rooms you have collectively, and what difficulties you think there might be in working in partnership. Getting a sense of your collective value will in turn help the lead GPs in your PCN understand how you can help them to meet their service objectives and, ultimately, persuade them that you should be paid for doing so.

You will also need a ‘lead’ community pharmacist to be the point of contact with the PCN and ensure that your LPC is informed of your progress every step of the way. LPCs will have a vital role in making sure that contractors have the guidance and advice they need to engage with PCNs, but also to be there to help where disputes arise or engagement is not working as it should. LPCs are also the route through which you can escalate issues to PSNC. There is much detail still to be worked out on PCNs, so don’t feel frustrated if you feel that you are behind the curve (many GPs are too).

Importantly, all this costs money: coming together to talk as a community pharmacy group within a PCN and, in time, talking to other healthcare providers too. I have been asked by many of you to negotiate a funding pot to help with this engagement, and I am not breaking any confidentiality if I say that it is absolutely on the PSNC list of requirements.

In Manchester last month, I gave a response to Ed Waller’s presentation by outlining the most common reasons (according to PwC) as to why business partnerships fail. Lack of vision (or clarity) on what we are trying to do; involving the wrong people; focusing on detail rather than the bigger picture; lack of trust; and poor decision-making processes were amongst the top. We have a vision for how PCNs will operate and the detail is emerging as to how they will work, and LPCs are already gearing-up to help pharmacies to engage with them. The one thing that only front-line pharmacists can do is ensure that we have the right people engaging with the PCNs, and that we all enter in to this new way of working in a spirit of mutual trust.

Waller is right: it will be uncomfortable for some – but it’s not impossible. Successful engagement with PCNs could bring significant benefits for local community pharmacies – whether providing clinical pharmacists to GPs or provision of subcontracted services. And don’t forget that in addition to the £4+bn routed to PCNs, there is an additional £3bn to CCGs for primary medical services. Collaborative and effective community pharmacy partnerships within PCNs could be a valued and trusted supplier for CCGs – benefiting the community, patients and the NHS.

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