A new challenge has emerged for PCNs with the advent of Integrated Care Systems – that of working effectively with each other.  To date joint working between PCNs has been something of an optional extra, but the transition to the new arrangements mean firm plans need to be put in place.  How are PCNs going to make this work?

The new guidance on Integrated Care Systems states,

“PCNs in a place will want to consider how they could work together to drive improvement through peer support, lead on one another’s behalf on place-based service transformation programmes and represent primary care in the place-based partnership. This work is in addition to their core function and will need to be resourced by the place-based partnership.” p28

This seems to be a gentle way of saying that not every PCN can be individually represented in the place-based partnership (the local arm of the Integrated Care System).  Instead PCNs need to find a way of being able to work together and represent each other.  Bear in mind that place based partnerships could potentially be making funding allocation decisions that will impact on the whole of primary care, so getting this right feels very important.

In some places this is not going to be a problem.  Effective joint working arrangements between PCNs are in place, often via a federation or shared umbrella organisation, and those PCNs will be able to use that system within the new arrangements.  However, in other areas no formal joint working mechanism exists, and for these the challenge could be much greater.

There is an underlying issue when it comes to representation, and making it work in practice.  It relies heavily on trust.  When an individual is at a meeting, do those he or she is representing trust that individual to work in the best interest of all, or are there concerns that he or she will make decisions on what is best for their practice or their PCN? If an opportunity arises, e.g. to pilot a new way of working, will everyone receive a fair opportunity to take it, or will the representative have first choice?

Even where motives are good, how strong and effective are the communication feedback loops?  Is each PCN canvassed for their views ahead of important items being discussed and a consensus reached ahead of time, and is timely feedback on decisions made provided to all?  Or do those that are being represented feel left in the dark, without any real idea of what is being discussed let alone decided?

It is concerns such as these that lead individual PCNs to wanting their own individual representative at system discussions.

Even for those who do attend the meetings, life is not much easier.  It is hard to comprehend everything that is being discussed, given the complexity around Integrated Care Systems (which even seems to have its own language!).  Worse, many are left with the nagging sense that the decisions seem to be made outside of the formal meetings, with the meetings themselves just a rubberstamping of conversations that have already taken place.

Of course that is to some extent true.  Integrated care is about relationships between organisations, which means relationships between individuals within those organisations.  It is not as straightforward as objective discussions within a meeting environment.  This begs the question as to whether what PCNs need is not one of the PCN CDs to ‘represent’ the others, but a senior manager who can operate at the same level of as the senior leaders of the other organisations, and who can be part of the decision making both inside and outside of the meetings.

Appointing such an individual would have the added benefit of being effectively neutral across all the PCNs, as well as potentially being skilled at pre and post meeting communication.

The problem for those wanting to go down this route is inevitably one of funding.  The guidance says that this work “will need to be funded by the place based partnership” so if a case can be made there is mileage in exploring receiving funding for such an individual directly from the ICS.  While for the role to be effective a senior and experienced individual capable of operating at director level is required, it probably does not have to be full time which would bring the cost down.  And with an imminent turnover of CCG Directors as CCGs are abolished at the end of March there may be secondment opportunities worth exploring.

This is not an issue that can be ignored any longer.  Whatever the local difficulties, it is important for general practice as a whole (the guidance says the PCN representative will “represent primary care in the place-based partnership”), and so it is important PCNs are working now to establish how they will make this work.

I take a more detailed look at how to create a strong voice for general practice in my free guide, “10 Steps to a Powerful voice for General Practice”, which you can access by simply signing up to our weekly newsletter here.