Strengthening and supporting general practice in Haringey
The NHS long term plan recognises the fundamental importance of primary care in underpinning NHS services. In this context, primary care networks (PCNs) are seen as key to delivering on the ambition to improve standards of care across the country through proactive, personalised, coordinated and integrated approaches.
However, the needs of our local communities are more urgent than ever. Concerns about persistent unaddressed health needs, health inequalities and the social determinants of health are growing, intensifying the stress on the system. In Haringey for example, there is a 15-year gap in healthy life expectancy between the richest and least well-off parts of the borough. The borough’s residents are reported to have significantly poorer health behaviours and outcomes compared with the national picture.
Additionally, PCNs and clinical directors face mounting pressure to balance the multiple challenges of delivering of positive health outcomes for their patient populations, recruitment and retention of a skilled, experienced workforce and the achievement of incentive targets upon which financial sustainability depends.
These significant system pressures place real capacity demands on PCNs. In response, Haringey GP Federation has developed a management support offer which is assisting the development of PCNs in line with the NHS long term plan.
According to research from the NHS Confederation undertaken two years after the implementation of PCNs, more than nine in ten PCNs asked said their workload was greater than expected, with the consistently high workload derailing existing and planned work programmes. New service specifications are causing confusion over the purpose of PCNs, while a lack of consistent infrastructure was seen as hindering progress.
This bespoke service that is tailored and scaled to the unique needs of each PCN. A bronze, silver, gold framework enables clinical directors to select the level and type of support that exactly suits their needs. This ranges from dedicated administrative support for matters relating to PCN management right up to full financial support for PCN DES delivery and bespoke project support.
Bronze: Administrative Support
- Access to support of dedicated admin support & assistance; ranges from PCN board agendas, minutes & support to CD
- Network manager covers all PCN related communication
- ARRS portal claim submissions
Silver: Enhanced Admin & Financial Management
- PCN network agreement & data sharing agreements
- Network manager tracks invoices, payments & claims
- Financial and accountant management of PCN bank account
- ARRS portal claims submissions
Gold: Enhanced Admin, Financial Management, PCN Development
- Full access to admin & network manager
- Senior manager sets strategic and operational priorities with CD
- ARRS portal claim submissions & bespoke ready reckoners
- High level financial support including invoice mapping and live finance trackers
- QI projects & coordinate PCN wider delivery on QOF QI indicators
- Dashboards: PCN DES delivery, IIF & LCS
- Bespoke project support, i.e. health inequalities
- Support for PCN workload through fielding demands from ICB & wider system
Aims and Ambition:
In keeping with our aim to strengthen and support general practice in Haringey, the Federation’s support package for PCN development is providing a centralised resource which helps busy clinical directors to manage capacity and demands.
Our structured approach ensures the administrative, operational and business support functions for the PCN are fulfilled to a high standard and in a timely way.
We work to the individual needs of the PCN to create a bespoke offer where additional support is needed, for example project management and delivery.
The offer further aims to make the most of cost sharing opportunities in order to secure vital efficiencies and make the best use of existing Federation infrastructure and expertise.
‘We are very pleased with the support we get from the Federation with regards to our PCN. The PCN meetings run smoothly and the minutes are sent out on time’
‘‘Excellent support to N15 PCN from the Federation team, they have been invaluable’
Benefits and Impact:
The benefits to PCNs and patients are clear:
- Increased capacity through additional well-trained workforce
- Improvement in PCN DES outcomes and IIF through performance reviews
- Elimination of duplication and introduction of efficiencies for example, agendas, papers are managed for all PCN meetings whilst PCN funding deadlines are supported and met
- At risk patients receiving the targeted care they need thanks to improved capacity to interrogate patient data
- Through management of ARRS, introduction and support for a vibrant variety of different roles in the PCN, including pharmacists, physician associates, social prescribers and care coordinators
One Haringey PCN that benefits from the gold support offer has positively transformed working relationships and has focused on working collaboratively and innovatively.
It achieved the vast majority of indicators under the Investment and Impact Fund (IIF), an incentive scheme focused on supporting PCNs to deliver high quality care to their population. This not only means achievement of healthcare targets is improving, as are patient outcomes, but provides reassurance around financial sustainability.
Regular meetings involving practice managers, clinical pharmacist and the Federation team scrutinised IIF data and developed strategies for the PCN to achieve each indicator.
Creation of dashboards, at PCN level enabled regular tracking of performance against the target indicators, and timely adjustment of strategies to respond to any unexpected fluctuations.
Support to access the expertise needed in data analysis and patient data searches meant that all practices and clinical director were able to better understand their data and what it meant in terms of effectiveness of patient care strategies.
PCN Dashboard Snapshot
Immunisations & vaccinations
- 3/3 key indicators on or above target
- 93.9% of patients aged 65+ received seasonal flu jab (Sep-Mar)
- 5/6 key indicators on or above target
- 60.7% of younger adult patients with concerning cholesterol levels referred for relevant genetic & familial diagnostics (vs target of 20-48%)
- 2/2 key indicators on or above target
Medicines review & optimisation
- 8/9 key indicators on or above target
This specialist service is providing valuable assistance to Haringey’s PCNs, aiding the delivery of the PCN Network Contract Direct Enhanced Services. In this way it supports the management of patient services that PCNs are commissioned to provide for their local populations as well as the associated specialist workforce requirements.
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