Steve Donlan, Co-chair of the Practice Management Network and Management Partner at Endeavour Practice, gives his view on the draft DES specifications
I chair my primary care network of around 49,000 patients covering five partnerships and recently found myself suffering another sleepless night. Unfortunately, on this occasion, I was not simply mulling over my never-ending to do list but I was awake because I was genuinely concerned about the draft PCN Direct Enhanced Service (DES) specifications. It feels like the cavalry that has been sent to save us from our heavy workload has joined forces with the other side.
My PCN has spent these last few months putting down the foundations for our new working relationships. A formal PCN agreement is in place between the member practices and our first social prescriber will start work in April with a national charity managing the contract for us. I think we are proud of the progress we have made considering the shortage of both clinical and managerial capacity. My practice manages the PCN finances and before Christmas I suggested that we should now start looking at procuring a pharmacist as we have enough funds to do so without calling on the practices to provide the 30% not directly reimbursed to the PCN.
But it takes time to sort these initiatives out on top of ever-increasing practice commitments at what is the busiest time of year. We will not have a pharmacist in situ and clued up from April. Nowhere near. Meanwhile it appears we could be expected to take on a significant number of medication reviews.
Then by June we would need to be spearheading preventative healthcare in specific care homes. My practice has 30 patients spread over 15 care homes and this fragmentation is typical within the centre of the town. It is great news to be given the go ahead to align PCNs to particular care homes but we must not underestimate the effort it will take to get us there.
So what is to be done? Well, we must not forget the strategic importance of PCNs. There is no Plan B. We need to work with our local local medical committees to lobby clinical commissioning groups to agree the commitments in the first year. For example, the draft guidance does give the CCGs some discretion on the volume of medication reviews that need to be completed. Otherwise, there is a very real risk that practices will start pulling out of PCNs putting greater strain on those that are left. And then the whole house of cards could start to collapse.
Meanwhile, at a national level, the Practice Management Network will ensure that our concerns are fed in to the powers-that-be. We cannot afford for the PCN horse to fall at the first fence.