I am lucky enough to be in a role where I meet lots of Primary Care Networks in different parts of the country.  One of the most common things they tell me is that they know that they are “behind” where everybody else is.

This is interesting for a range of reasons.  Firstly, if everybody is behind everybody else, who is in front?  The influence of social media is such that when we hear a few PCNs report on what they are doing, our immediate reaction is to think we are not doing that so we must be behind, even without knowing anything like the whole story of what is going on in that other PCN.  By and large we tend to share what we are doing well on social media, not what we are struggling with.

Secondly, what does being “behind” actually mean?  How do we determine if a PCN is ahead or behind?  Is it the extent to which they are meeting the DES requirements, meaning the PCN that has a network agreement, a data sharing agreement, a social prescribing link worker and a pharmacist is ahead, and those that don’t are behind?  I am not convinced this is going to be the best indicator of ultimate PCN success, because it is possible to have all those things in place simply with a level of passive compliance from member practices as opposed to any active ownership.

Maybe it is distance along the PCN maturity matrix that is the best measure of progress?  Just in case you haven’t fully internalised the PCN maturity matrix, it identifies five components of a PCN development journey: leadership, planning and partnerships; use of data and population health management; integrating care; managing resources; working in partnership with people and communities.  Now I wrote back in August about the dangers of a nationally prescribed maturity matrix imposing requirements or expectations on a PCN.  Ultimately each PCN should determine its own purpose, and make its own decision as to what its maturity would look like.

Thirdly, is being ahead a good thing?  If we have learnt anything from the DES specifications it is that showing a little bit of caution may actually be wise in the current environment.

As regular readers will know I am a big fan of Professor John Kotter at Harvard and his approach to change management.  He believes assuming people know that change is needed, and focussing instead on strategy and solutions (like PCNs) is what kills most change efforts.  He differentiates between a “false” sense of urgency whereby people feel anxious, angry and frustrated, and a “true” sense of urgency whereby people have a powerful desire to move, successfully, now. The former does not lead to taking action, but the latter does. GPs feeling under pressure and angry is not the same as GPs wanting to make a change and make PCNs a success.  There is work for PCN leaders to do to get to this point.

So if PCNs are ultimately an exercise in change management, which is what makes them difficult, then moving too quickly into doing things without spending time coalescing around a shared vision is likely to be a recipe for long term failure.  Meeting contractual requirements, or ticking the boxes on the maturity matrix, are a long way from winning the hearts and minds of member practices and local partners.

PCNs are not a race.  There is no prize for being “ahead” (whatever that means).  Taking time at the start to understand what the PCN is for, and what transformation its members want it to deliver, and building trust across the network (however long this takes) is key to making the most of the opportunity that PCNs provide.