Primary Care Networks (PCNs)
Primary Care Networks (PCNs)
On 31st March 2017, NHS England published Next steps on the NHS Five Year Forward View, which reviewed the progress made since the launch of the NHS Five Year Forward View (5YFV) in October 2014 and set out a series of ‘practical and realistic steps’ for the NHS to deliver a more joined-up and responsive NHS in England.
One of those steps was to encourage general practices to work together in ‘hubs’ or networks. This is because a combined patient population of at least 30,000-50,000 allows general practices to share community nursing, mental health, and clinical pharmacy teams, expand diagnostic facilities, and pool responsibility for urgent care and extended access. It also involves working more closely with community pharmacists, to make fuller use of the contribution they make.
In February 2018, Refreshing NHS Plans for 2018-19 set out the ambition for CCGs to actively encourage every general practice to be part of a local primary care network (PCN) so that these cover the whole country as far as possible by the end of 2018/19. There are various routes to achieving this, including the NAPC Primary Care Home (PCH) model, general practice federations, ‘super-surgeries’ and multispecialty community providers. CCGs and local Sustainability and Transformation Partnerships are working to accelerate the adoption of this type of collaborative working to enable more proactive or ‘extensivist’ primary care.
NHS England are currently (November 2018) providing support to CCGs and STPs to develop PCNs at a local level. It is anticipated that further support for the concept will be included in the NHS long term plan, which is expected to be published in December 2018.
What are Primary Care Networks?
PCNs are based on general practice registered lists, typically serving natural communities of around 30,000 to 50,000 patients. They should be small enough to provide the personal care valued by both patients and healthcare professionals, but large enough to have impact and economies of scale through better collaboration between general practices and others in the local health and social care system, including community pharmacies.
This short NHS England animation explains the concept of PCNs and how this new way of working enables health and other services to work together to provide better access for patients:
The PCN concept is broadly based on the National Association of Primary Care’s Primary Care Home (PCH) model; see below for more information on the PCH model.
The Primary Care Home model
The National Association of Primary Care (NAPC) launched the Primary Care Home model at their annual conference in October 2015. The PCH model is designed to support the strengthening of primary care in line with the new care models outlined in the NHS Five Year Forward View. The programme was supported by NHS England.
PCH is an innovative approach to strengthening and redesigning primary care. The model brings together a range of health and social care professionals to work together to provide enhanced personalised and preventative care for their local community. Staff come together as a complete care community – drawn from GP surgeries, pharmacy, community, mental health and acute trusts, social care and the voluntary sector – to focus on local population needs and provide care closer to patients’ homes. PCH shares some of the features of the multispecialty community provider (MCP) model, but its focus is on a smaller population (30,000 to 50,000 patients) enabling primary care transformation to happen at a fast pace, either on its own or as a foundation for larger models.
NAPC received almost 70 applications to be part of the initial phase of the programme and the successful fifteen rapid test sets were announced on 17th December 2015. In late 2016, additional ‘Community of Practice’ sites joined the programme. Details of these sites and further information on the programme can be found on the NAPC website.
In August 2017, the Nuffield Trust published an evaluation report of the PCH model, which looked at how sites can make early progress with implementing and evaluating their local PCH models and potential challenges.
The following short NAPC video illustrates one example of how community pharmacy is participating in the PCH model:
Guidance on how community pharmacy can get involved
In May 2018, the NAPC published a guide to inspire further integration of community pharmacy within PCHs, with the aim of improving patients’ health and supporting them to manage their conditions. A forum of clinical leaders within community pharmacy developed the guidance, examining ways in which further collaboration between PCH sites and community pharmacy could be encouraged to ensure pharmacies are integral to supporting the health and care needs of patients within PCHs.
The guide Primary care home: community pharmacy integration and innovation looks at ways Local Pharmaceutical Committees, community pharmacies and PCHs can make greater use of pharmacists’ skills as part of a PCHs’ whole population health management approach.
It focuses on the three key roles for community pharmacy outlined in the Community Pharmacy Forward View: a facilitator of personalised care for people with long-term conditions (LTCs), trusted, convenient first port of call for episodic healthcare advice and treatment, and a neighbourhood health and wellbeing hub. It also proposes a list of actions to galvanise PCHs and community pharmacy to come together to create innovative solutions to the current challenges and improve services for their local population.
While there may not be a PCH site in all areas of the country, the recommendations in the NAPC guidance can still be applied in seeking to improve collaborative working between community pharmacy and other professionals within primary care networks.
The guide proposes five actions for LPCs and leaders of PCH sites/PCNs:
- start conversations between leaders of PCH/PCN and LPCs to work in partnership;
- adopt “Walk in my shoes” to gain an insight into each other’s working environment;
- develop a joint engagement strategy and co-design new services with patients and communities;
- align population health needs with the potential for community pharmacy; and
- explore the community pharmacy workforce needs to create workforce redesign and a culture of greater integration