Hitting the DES but missing the point…
How the true promise of PCNs has been clouded by traditional NHS command and control thinking.
As with many well intentioned initiatives, PCNs working and development has, in many cases, been reduced to a series of tick boxes, tasks and contract lines.
This classic contract and specification roll out approach and the use of funding as an incentive has three principles issues:
It creates passivity in the recipients. It becomes yet another box ticking exercise (like QOF).
The very innovations and solutions that were supposed to be locally created and led, have been defined by someone else - often with little understanding of the work or the community served.
The promise of PCNs is hidden by a rush to meet the specifications and externally imposed deadlines.
PCNs have been tasked with a huge remit. Central to this is the integration of primary care services. The fact that countless top down and well funded initiatives have failed to deliver this should give us a clue to the complexity of this task, and some of the systemic barriers that exist. While PCNs are ideally placed to achieve this, they wont if they are rushed into action before they have got the foundations of true network working in place.
This rush is centred on the DES’ for the seven core service specifications. These provide a task focused view of solutions for such areas as greater anticipatory care, medicines optimisation, early cancer diagnosis and tackling neighbourhood inequalities.
The intention of these service specifications is noble, but the core principles of truely achieving them require a profound shift. For example tackling neighbourhood inequalities requires a shift to asset based relationships with communities. To become more anticipatory requires a more proactive model - a model that is not fixated with access but is focused on meeting need regardless of origin.
These shifts challenge the very model of medicine that many professionals and the system are accustomed. The rush to achieve the tick boxes will result in PCNs not questioning the work, not engaging with communities and not pushing the boundaries; because to do that you really need to own the process, not be a passenger in it. The result will be the DES’ may be achieved but precious little of the systemic promise of PCNs will be seen.
Now we are not nieve enough to think the DES’ are going away, and when approached in the right way they can provide a useful catalyst. For primary care to make inroads into improving things for people with the most complex needs, those who tend to fall between the cracks of our fragmented systems, PCNs need the headroom and development support to not only consider the specifications, but also bring their members together around a common purpose and mutual understanding of what working as a network really is.
Click here for a further expert blog on the organisational considerations for PCNs considering the seven PCN service specifications.