Updated: Dec 5, 2022
As always, we write our content for new Primary Care Network Leaders. With a spotlight on winter pressures in the news, we thought this would be a good opportunity to highlight the importance of this busy period and help networks to consider where they could lead, act as a supportive partner or delegate on certain areas to reflect their capacity.
To showcase the practical application of the lead, act, support or delegate framework, we have provided examples of how this is being delivered in Warrington Innovation Network.
Let's jump in!
The NHS is constantly under significant stress and strain trying to meet the needs and expectations of patients.
On 12th August, NHS England reported:
“Urgent and Emergency Care staff have faced one of their busiest summers ever with record numbers of A&E attendances and the most urgent ambulance call-outs, all alongside another wave of COVID-19.
The NHS continues to provide care to over 100,000 urgent and emergency care patients each week. Despite their best efforts, these pressures have meant that there have been too many occasions when staff have not been able to provide timely access for our patients in the way they would have wanted.”
The full publication can be found here.
So, what are winter pressures and how does this period differ from the norm?
Winter pressures is an NHS term that defines the spike in demand when an already stressed system experiences increased pressure impacting patient wait times, workforce capacity, well-being and health and care financial budgets.
Winter pressures also encompasses many illnesses relating to respiratory diseases, flu, chest infections and other conditions that respond poorly to cold weather peaks in the winter.
Another problem that the NHS faces during winter is an increased risk of infection in healthcare settings where patients with weakened immune systems are at increased risk of becoming seriously ill.
Whilst we know winter pressures in our health and care system is predictable, with a significant amount of planning taking place to mitigate risks and issues, there is always an element of uncertainty.
Over the past couple of years, there was more of a command-and-control approach to winter activity during the height of the pandemic; primary care networks currently have a little more flexibility to plan and design their own provision and, where possible, be ready for the peak.
What can PCNs do to support patients and protect their workforce this winter?
Whilst many practices have their own contingency plans to tackle this busy period, this could be an opportunity for PCNs to come together, review their workforce, and decide where they will either lead, be a supportive partner or delegate to maximise their impact.
For example, the approach that Warrington Innovation Network (otherwise known as WIN) is taking is;
The COVID-19 vaccination programme will be led by their neighbouring PCNs.
This is an example of delegation.
The new enhanced access DES that began on 1st October has been subcontracted to the federation.
This is an example of delegation and being a supportive partner.
WIN is investing in a care home winter pressures campaign which will involve;
Diverting work away from practices
Being delivered by a dedicated PCN care home team comprised of 6 GPs
Flu vaccinations delivered at PCN level
Ensuring care home records are up to date to aid quicker and easier decision making
This is an example of the PCN taking the lead.
One practice is investing in enhancing its telephone system to enable more streamlined patient access, with a view that this can be rolled out across the PCN following a successful pilot.
This is an example of a practice taking the lead.
The PCN is also regularly reviewing PCN appointment slots to ensure services are being utilised and making changes to improve utilisation. This has resulted in the network increasing its pharmacy provision to help maximise the additional role reimbursement scheme, alongside moving all FCP appointments to face-to-face, which is commissioned via Pure Physio.
This is the PCN proactively taking the lead to review and manage its
Effective communication is always key and even more so during busy periods, and the network is in the process of reviewing.
The frequency and purpose of meetings and optimising to maximise productivity and engagement
The format of communications to ensure they are clear and timely and are sent to all practice and PCN staff
Annual leave and rota allocation is also being carefully reviewed
Actions for consideration
🎯What plans do you have in place to help address the potential issues that could arise this winter?
🎯Could you proactively decide where you are going to lead, be a supportive partner or delegate to protect your team and to provide the best care to your patients?
Check out the Supporting general practice, Primary Care Networks and their teams through winter and beyond document published by NHSE on 26th September 2022.
The highlights from this document cover:
Issuing a variation to the Network Contract DES to make several changes:
Introducing further flexibility into the Additional Roles Reimbursement Scheme (ARRS) (see annex 4 for full list), including the addition of a GP assistant role to help reduce the administrative burden for GP teams, and a digital and transformation lead role to support patients and practice teams to optimise digital tools and embed transformation
Retiring or deferring four investment and impact fund (IIF) indicators worth £37m, and allocating this funding to PCNs via a monthly PCN capacity and access support payment, for the purchase of additional clinical services or workforce to increase access to core services this winter.
Reducing the thresholds of two IIF indicators and changing the definition of a further two IIF indicators to make them easier to achieve
Removing the personalised care requirement for all clinical staff to undertake the Personalised Care Institute’s e-learning refresher training for shared decision-making (SDM) conversations.
Making changes to the anticipatory care requirements to support PCN capacity over the winter, and to reflect the revised national approach of phased implementation of this model of care from April 2023.
We hope you found this useful.
About the Author
I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 200 episodes.
I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 50 PCNs by providing interim management, training and consultancy.
I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.
I have three children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a massive role in my life.