Primary care networks need flexibility and local control

With further news expected on revisions to the proposed DES Dr Mark Spencer, Clinical Director of NHS England’s Primary Care Network of the Year 2019, Healthier Fleetwood PCN reminds us why flexibility is vital…

In Fleetwood we have been working together with our community towards a new and better model of primary care for some six years, embracing the ethos of the primary care home. We are proud to be seen as a good example of what can be achieved in primary care where there is vision, commitment and flexibility. We were awarded NAPC Primary Care Home of the Year Award in 2018 and the NHS England Primary Care Network of the Year 2019.

Unfortunately, the draft DES left us feeling disappointed. We believe that delivery of these nationally directed service specs as proposed was impossible. Implementation would have significant workload implications for general practice which is already stretched. In fact we believe it could have been significant enough to damage practices and send us back to the days when GP recruitment and retention was impossible due to spiralling workload.

Fundamentally the specs as proposed did not help us address our local priorities, in fact they would have meant that resources would be drawn away from these key local areas. Our priorities are children’s mental health issues and adults with complex drug, alcohol and mental health problems. These priorities are a result of our local health needs analysis and are the priorities identified by local residents. The ability to continue to focus on these priorities is essential. In order to succeed PCNs need flexibility and the opportunity to prioritise local needs over a nationally prescribed model.

It is vital for PCNs to be able to stabilise general practice and to make it a more attractive place to work in order to address worsening recruitment and retention issues. We are concerned that these efforts would have been seriously hindered by these service specs. Locally they would have undermined our new ways of working which we have developed together and which have ensured our survival against a challenging set of circumstances over the last six years.

The risk of destabilisation is so significant in Fleetwood that practices locally, including my own, have indicated that they would have had to withdraw from the PCN DES on 1st April.

In Fleetwood it is vital to maintain the flexibility to address our local needs and to work in new ways which support retention; help us operate more effectively and allow us to meet challenges together. We hope revisions to the draft DES will allow scope for this.

Integrated multi-professional, multi-agency working is built on a foundation of trust, with relationships forming over time, focussed on a joint sense of purpose and facilitated by actively listening to what matter to people, be they residents or frontline staff. What I found the most challenging aspect of this proposed top down approach within the service specifications was that they would be counter productive to us. I believe that in adopting them they would have ridden a coach and horse right through those relations we have worked so hard to build.

We have developed a way of working that pays attention to being connected, increasing self-confidence and being in control. This means residents being in control of their own health and their own lives, and frontline staff being in control of their working environment. Being connected, confident and in control builds hope for better future, creates energy and optimism and galvanises people to make a difference. This is what we’re passionate about, making a difference. Being in control of our working lives and making a difference will genuinely solve the recruitment and retention issues that face general practice.

We believe that we are genuinely making a difference in our community. What we need from the new service specifications is to be empowered to continue to do so and to be trusted to get on with it in the right way for our local community.

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