Improving the Primary Care Network DES service specification

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Improving the Primary Care Network DES service specification

 

How to improve the PCN DES

 

Welcome, please comment and I will try an answer

 

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Check out my original review where I went through the DES: here--https://youtu.be/K1qwyxt63f0

 

Declaration - I am not involved in the negotiations. I am Nottingham City East PCN Clinical director but these are my own thoughts. For some backstory in 2015 I wrote a further Blueprint for Primary care : https://egplearning.co.uk/a-further-blueprint-for-primary-care/ with a colleague as Jeremy Hunt launched the five year forward view. Some of these aims have been achieved (indemnity) but much can still be done. 

 

How to improve the DES- I will talk firstly about general changes and the headline points. Then each specification in turn with my more innovative (controversial) ideas at the end.

Ethos

 

The release time of the specification has caused a lot of frustration. Even more so in the first webinar where little engagement was offered, just reading the spec. This led in part to one CD resigning live. NHSE doing an open consultation on the draft is a good thing. Feigning listening is not. 

 

At points, the specification makes reference to evidence. In particular vanguard projects. However, it neglects to mention that vanguard projects have had significant higher levels of funding for each aspect and therefore converting this to specifications for networks to follow is a fallacy. 

 

You cant use a recipe that feeds four people that costs £10 and say provide the same meal for £2 all the time - even with using foodbanks. 

 

The original outline of the DES was to stabilise primary care. This draft does not do this but further destabilises it by utilising the additional roles above the capacity of work the can create and negates the fact networks will be part funding them. This was a poor way to show that NHSE/I was listening to the needs of general practice. Many comment the draft is intentionally too far to the right to allow any softening to be accepted as better than the original. This is a sceptics dream. 

 

For this process to work- show General Practice that NHSE is truly listening. Much of this has been done amazingly by Dr Nikki Kanani and I do not envy her position. I am mindful of do not shoot the messenger being very apt here. 

 

Lets move on. The following is a combination of my views and those from the various forums I engage in. 

 

Trust 

 

General practice. If I had control I would keep existing structures that could help foster better collaborative working and simply offer the resources to networks to use for their local area. 

 

General Practice has proved to be the most cost-effective method of delivering healthcare currently doing 90% of the NHS workload for less than 9% of the funding. Trust the networks to deliver primary care with the simple metric of improving the health of the network population. 

 

Ideally to the global sum but is not then to the networks directly to use as they seem fit to provide roles or services for better patient care along them 5 categories as best for their population. 

 

However, we do not live in a world of trust despite GPs consistently being the most trusted role in the country. 

 

So if working towards the confines of adjusting the existing DES and its specification let us have a look. 

 

Worth looking at the Berkshire, Buckinghamshire and Oxfordshire LMC