Four and half years into PCNs and it is no surprise that in that time things have not stayed the same.  One thing that has changed more than anything is the role of the PCN Clinical Director.  But has it evolved far enough?  What does the role need to be going forward to ensure future success?

When PCNs first started the role of the PCN Clinical Director was very much about start up, about getting the practices engaged in the PCN and enabling the PCN to take its first steps as a collective unit.  A whole raft of seemingly endless recruitments followed, liberally interspersed with responding to a global pandemic, setting up a vaccination programme, and an ever-increasing set of demands upon these fledgling organisations.

For much of that time the focus of the PCN Clinical Director out of necessity had to be internal.  In many PCNs no other capacity existed, so for anything to get done it was down to the PCN Clinical Director to do it.  But over time, gradually, this has changed.  PCN managers have been appointed, and more recently these have been supplemented by more senior Digital and Transformation Leads.  Throw in some administrative support and some PCNs can now even lay claim to having management teams in place.

With the rapid expansion of the additional roles many PCNs have introduced clinical leads, e.g. to look after the supervision, training and development of the clinical pharmacists or the physiotherapists or the social prescribing link workers, or to lead on some of the many operational components of the PCN DES such as the IIF or the new access requirements.  Meanwhile the role of the PCN Clinical Director has been evolving into one supporting this range of management and clinical leaders, as opposed to one directly delivering the work.

Some PCNs are much further down this road than others, but it is an important journey to take.  Looking into the future what practices will need from their PCN Clinical Director is a much clearer external focus.

The future direction for PCNs is to be part of Integrated Neighbourhood Teams (INTs).  As these have started to develop we can see that the PCN is the unit of general practice operating within these local teams.  A key part of these being successful, or making any form of difference, will be the relationships between the different organisations that are involved.  For PCNs this means that someone has to have the time to invest in building these external relationships, and that in most instances means the PCN Clinical Director.

At the same time the ability of general practice to operate effectively as a collective unit within a local area is becoming more important than ever.  Increasingly we are seeing decision making about general practice being shifted from a primarily national locus to a local one.  It is highly likely that in the coming months much more of the funding for general practice and for PCNs will come through local systems.  PCNs (like it or not) are the main units of general practice within an integrated care system, and so the voice and influence of the PCN Clinical Directors will be hugely important.

PCN Clinical Directors need to have the capacity to build the relationships with external organisations and wider local general practice to be effective going forward.  They will not be able to do this if they are stuck managing the day to day operations of the PCN.  While many have started the journey of releasing the capacity of their CD, for many there is still a long way to go.  Getting as far as possible by March next year is likely to be of critical importance both for the future success of the PCN and of local general practice.