Meeting Needs and Getting Upstream on Prevention
There are two key and neglected purposes of PCNs:
Meeting the needs of people who are too complex for a general practice to handle on its own, but not so complex that they are primarily the business of secondary care
Getting upstream into prevention and supporting people who don’t access health
Focus Your Time on the Main Purpose of the PCN: Meeting Complex Needs
In the meetings I’ve been too there is real energy about understanding their communities needs and finding better ways of meeting these. All PCN meetings should have the majority of their time spent on this work. My suggestion is that participating practices bring a ‘deep dive’ notes review of a few of their complex patients – the ones they know are bouncing round the system – mapping all the dates in a year or two where that patient has ‘touched’ the health system (hospital, outpatients, district nurse, GP etc). Here is one set out as a list and a ppt
Which of the patients notes you have reviewed together do you think you can solve at PCN level? Put a couple of hours aside at a PCN meeting and talk this through. It will really help you both clarify what the PCN is for but also what you think you can do better together. If you don’t think you can – who can? ICS? For the ones who you think you could do better for, with the help of others in the system, work out who else you need and bring them to the table. Start designing solutions together with other partners. Collaboration is at the heart of the PCN.
An example of a solution that lies just within the collaborating practices
This is the real work of PCNs. To do it you need to know who is attending frequently and why. We know that about half of people who attend frequently have really complex needs; and about half their problems dissipate over time and another cohort replaces them. The second group are probably the work of general practice, the first group could provide the patients/ people and families who need a more joined up approach.
This is meaningful work, it will engage your practices and generate energy and resources.
Getting upstream into prevention and supporting people who don’t access health
We have found that a lot of people (particularly young people) don’t access services at all – they are storing up problems for later life that could be nipped in the bud.
The red shows how few people are accessing this practice from ages 7 to 28!
Not only that but general practice is there for the whole population, and some people are just not being served.
So these young people are paying for services you are providing elsewhere. What do you know about this across all your participating practices? If you had a look at this data you might want to collaborate to reach the younger people who need, and deserve your services. You can use your social prescribing fund to pay for a wellbeing coach for schools. Right now with children and young people so affected by the current context they need primary care to listen.