Agenda item

This report provides an overview of Primary Care Networks and explains how they will be organised in Hammersmith and Fulham.

Janet Cree, a colleague from H&F CCG and Dr McLaren provided a brief overview of primary care networks (PCN) and how five PCNs would be configured in Hammersmith and Fulham. The concept of PCNs was described as a group of GP practices working together to provide population healthcare. This was not a new concept but offered formalised, structured and developed links within the context of wider changes to GP contracts. 

The five-year NHS LTP was issued in January 2019 and the direct enhanced service (DES) timeline extended to March 2019. Considerable work had been undertaken with GP practices to obtain the best provision to meet the needs of residents.  The PCN structure had been formally agreed and PCNs practices had signed up to it in addition to their core GP contracts and the DES. This was envisaged as a group of practices delivering a group of services for a portion of the population.  The network DES would receive funding to appoint directors and offer extended healthcare access across the population from 1^st July.

Details had not yet been provided and in April 2020 there would also be a requirement for each of the PCNs to deliver on the specifications.  The PCNs would deliver a range of services provided by health professionals working alongside the GP Federation.  The services would be wide ranging with a significant impact and would be mobilised as quickly as possible.

Councillor Coleman enquired about social prescribing and it was explained that work was ongoing to recruit social prescribing link workers for each of the three PCNs.  The CCG would also be providing training to Patient and Public Involvement (PPI) groups.  Meetings with groups would be held at network level and working with them was a priority for the CCG.  This was a big change in the way in which things were organised but there was a requirement to produce plans in a very short time.  It was important to understand what it was that PCNs were required to deliver and the anticipated journey.  Some additional investment was to be provided to enable clinical delivery going forward. 

The role of clinical directors and their specific role would be key in developing the foundations of PCNs.  The five PCNs for Hammersmith and Fulham would include GP At Hand, each covering between 30,000 and 70, 000 patients.  With reference to GP At Hand, it was stated that from the CCG perspective, the aim was to respond and support patients that were part of the GP At Hand network (approximately 71,000), even though they did not all meet criteria of placed based commissioning. This would have to be further considered going forward as it involved a significant number of patients of which only 17, 000 were resident within the Borough.

Councillor Richardson enquired what would be different following the introductions of PCNs and the potential impact on the day to day provision of health services.  Dr McLaren was unsure if he could explain this fully.  There were huge challenges to be addressed with insufficient time or resources.  Excellent directors had been appointed and he was hopeful that they could adapt these roles to their professional, clinical commitments.  The Federation was to deliver the PCN agenda and would collaborate to ensure that they work efficiently but the PCN was in the early days of implementation. The main area of work was around social prescribing and plans to submit a bit to Macmillan fund were in train. 

Councillor Coleman was encouraged by the increased number of social prescribing link workers and was keen to support this working with GPs and the PCNs. 

Keith Mallinson welcomed the report and the support being offered to PPI groups referenced on page 66 of the Agenda pack being considered at a network level.  Healthwatch also welcomed the opportunity to be involved in the PPI offer and Janet Cree suggested that he contact Bethany Golding who was a key part of this work.

Councillor Richardson welcomed the work on integrated care and enquired if there would be an opportunity to scrutinise the PCNs, given the time and resourcing issue.  Janet Cree confirmed that PCNs would be discussed in more detailed at the forthcoming HISPAC meeting.  The plans for the PCN were evolving and developing.  It was important to identify the measurable aspects, whether they were achieving intended aims and objectives.  It was envisaged that this would form part of the scrutiny process but not immediately.

Sue Spiller expressed her interest in the planned engagement and involvement with the third sector.  These were small, well placed organisations that were well placed for engaging with local communities and she was keen to understand how SOBUS could support work on social prescribing and how this could be facilitated, encouraged and supported. Janet Cree responded that there was an opportunity to do this through the integrated care partnership. 

Councillor Coleman asked that if the aim was to signpost residents to what was available then the third sector would need to respond.  He asked if the CCG would support the third sector through investment or additional resources.  Janet Cree responded that from a partnership perspective the CCG also worked with other organisations and that if there was to be a shift in resources this would need to be included in the work programme and be further discussed. There was a lack of clarity currently within primary care as to what could be provided by the third sector and it was hoped that this could be addressed through the work on social prescribing and improving the interface with the third sector.

  Sue Spiller concurred that it was not just a matter of funding but that it would take time to make the shift in perspective which will attract better resources.  However, understanding how this would work together in practice was complicated.  There was a need to balance existing provision and adjust offers accordingly through the PCN.  Vanessa Andreae added that this was an excellent opportunity to have the involvement of the third sector.  The DES was about widening the scope of the offer and highlighted what else may be on offer in the community.  The information and communication about this needed to be correct and a local conversation about the PCNs was essential, for example, the third sector being represented on PCN boards, acknowledging that there were different resident demographic profiles in different geographical parts of the Borough. 

Councillor Richardson asked Dr McLaren about his view on the changes given how hard GPs currently worked and the views of his GP colleagues. He explained that the mood was positive with some practices anxious about working more closely together and what this might mean.  Generally, there was a sense that practices were going to have to rely on PCN income to survive. 

Councillor Coleman enquired whether the aim was to replace contracts.  Janet Cree responded that there would be two elements: a core contract, and then in addition, the PCN DES which was growing in scope.  Most of the work was to potentially shift resources to becoming more population based. It was confirmed that there would be 72 PCNs across London and that it would be the same process from everyone as they would all be responding to the need to align with the requirements of the integrated care system (ICS) level organisation.  These would have a bigger footprint across all the boroughs and there would be 55 ICS across the country.

Councillor Coleman commented on the CCG support for the merger and observed that the intentions outlined by Mark Easton (Accountable Officer, NWL Collaboration of CCGs) were unclear, bringing together many different elements at the same time.  Janet Cree replied that the merger of the CCGs was about how commissioning staff were organised within the borough, finance and office administration, and that part of this was about setting up the PCNs.  This was the part that was also affected by the merger but the staff supporting PCNs and GPs remained in place and this would not alter.

It was confirmed that the PCNs were evolving and that further development would be undertaken once the specification had been provided and that this would have a long-term impact.  There would be seven specifications in total, five of which would be in place by April 2019 and two further ones to follow by 2021. Janet Cree added that the CCG was also commissioning services across the Borough and was that this already included in part of the work being undertaken.  It was noted that setting up the PCNs in themselves was not enough which was why there was a need for the NWL merger to be in place to provide an overarching infrastructure in the form of an ICS.  The LTP commissioned an eight-borough delivery model and the merger was happening because of the expectation that the CCGs would align with the ICS for logistical reasons.  The merger therefore, was the delivery vehicle for commissioning intentions.

 Lisa Redfern commented that it was difficult to understand the whole system, particularly given the variation in terminology and the way this had evolved.  Janet Cree confirmed that there was a plan about how this would be delivered and acknowledged that there had been a mixture and overlap of terminology, both old and new. The STP no longer existed and the ICS was current.  The five parts of the STP also no longer existed.

One of the items expected to be discussed at HISPAC would articulate how the local authority could influence and shape outputs required to facilitate delivery of the LTP.  Dr McLaren (as a clinical director) reported that practices were generally positive about the change and saw potential improvements in the way primary healthcare was offered in terms of the support they might receive.

RESOLVED

That the Board noted the report.