“To me, ideas are worth nothing unless executed. They are just a multiplier. Execution is worth millions.” – Steve Jobs

We could debate whether or not Primary Care Networks are a good idea, but the idea contains enough potential (practices working together, general practice partnering with the wider health and social care system, a focus on the specific needs of a population of c50,000 etc) to state that their success will not be determined by how good the idea of PCNs is, but by how well they are delivered in practice (or “executed” in Steve Jobs parlance).

Lots of people have good ideas.  Some people think their ideas are so good that they pay for a patent on their idea, so that other people can’t steal it.  Forbes reported that, ‘of today’s 2.1 million active patents, 95 percent fail to be licensed or commercialized’.  Most ideas stay as simply that, ideas, and never become a reality because they are never executed.

PCNs are an idea.  At present they exist in the conceptual, and in nascent governance frameworks, but try asking a hospital consultant what a primary care network is.  Their success will not be determined by the size of the population they serve, or whether they have a network agreement in place or have appointed a Clinical Director, but by whether they actually start to deliver and make change happen.  PCNs are still an idea needing to be executed.

Studies into successful change in the NHS have found that there are three critical components of success: clinical leadership, senior support and project management.  Clinical leadership in PCNs comes through the PCN Clinical Director, who has dedicated time to undertake this role (although last week we discussed the importance of protecting this time to make change happen).

Senior support in other organisations of the NHS usually comes from a director who can link the change effort with the organisation’s priorities and the wider senior team.  For PCNs this role can be fulfilled by the PCN Board, who generally have partner level representation from all member practices.

The third component of successful change is dedicated delivery capacity in the form of a project manager.  It is extremely difficult when a PCN CD only has a couple of sessions a week, and practices are working on top of the pressures of the day job, for changes to be made and new ways of working to be introduced.  Change, as we have discussed many times in this blog, is hard, and without dedicated project management it is very difficult to find the capacity to overcome the blocks that will inevitably emerge along the way and make it happen.

While project management for PCNs is not directly funded within the contract, the good news is that PCNs are all being given significant development funding, that will continue over the five years of the contract.  My very strong advice is that PCNs prioritise the use of this funding to establish capacity to deliver change and employ dedicated project management support.

I have met a number of different PCNs on my travels over recent months, and one thing I have noticed is those PCNs who have dedicated delivery capacity in place are the ones who have been able to achieve the most.  The real value of PCNs comes with their ability to execute.  At this point in the development of PCNs, when moving from idea to execution is the critical next step, there can be no higher priority than getting in some dedicated project management support.