We have had the concept of neighbourhood working for some time – it makes sense to plan and deliver services within the communities where people live. This has taken a number of forms and TLAs (sorry – three letter acronyms) and covered various population sizes.
In the last few years we have seen concepts becoming more crystallised around Integrated Neighbourhood Team, Integrated Care Communities and Primary Care Collaboratives. There have on occasions been power struggles and pre-emptive strikes as to just who owns the entity. Is it the Community Provider, linking in to social services and the third sector, in which case GPs have felt marginalised? Has it been the GPs working to a predominantly health agenda working “at scale” with the immediate primary care team. Where this is occurring, it has largely been informal collaboration within a developmental and innovative environment
There have been attempts to encourage the concept of primary care homes that bridge the gap between the two extremes and provide a comprehensive integrated offer to a locality. Within our region there have been spectacular successes and disappointing failures.
The debate has now ended, at least as far as health is concerned. The Long-Term Plan and GP Contract settlement clearly sets out the NHS stall around primary care networks of between 30,000 and 50,000 population. The leadership of these networks will come from GP Clinical Directors.
So what does this mean to the various players? I don’t think everyone has yet got their heads round this new kid on the block, particularly where community staff have set up their own version of neighbourhood working. There is a temptation that they will carry on as before, treating the PCN as a separate entity where the GPs “do their collaboration.” And elsewhere smaller ICCs have been established based on local geographies and allegiances. They are just settling into their working arrangements and relationships when they may be forced to amalgamate with an adjacent ICC. And established funding streams will be disturbed as further investment is directed at PCNs.
The worst outcome will be that the two entities try to exist side by side; what must happen is that integrated neighbourhood working within a collaborative GP practice arrangement must become the norm. This is going to take some delicate organisational development work with all stakeholders.
We are also seeing emerging angst about how individual practices are to be incorporated into networks. Some dispersed practices (usually by acquisition of a number of small practices) straddle more than one network or geographical entity. They are arguing to be treated a s a special case. There are other instances where individual practices don’t want to engage with other practices within a network as they “don’t get on.” I do hope these practices can see the greater benefit to their patients of working in a neighbourhood that makes sense geographically and logistically to provide the community with wrap around integrated care. After all, how many other health workers can choose who they want to work with!
I find it surprising just how much weight and expectation is being put on the PCNs within a relatively short time scale. There may have been a developing willingness to explore collaborative working when there was informality and no pressure. However, this may no longer be the case as PCNs are formalised, have clear accountabilities for delivering prescribed priorities and become sucked into NHS bureaucracy and performance requirements. Will they become mini CCGs or PCGs? (for those who can remember the brief flourishes of such entities.)
One thing is clear – this is a sea change in the way health and care is delivered. We need to make it work.