Primary Care
In many ways, it serves as confirmation of changes primary care leaders heard were coming for some time. Merging eight PCN service specifications into one, there’s been an overall effort to streamline requirements and provide greater flexibility to organisations.
That said, there are some headlines. And in this five minute brief, we analyse the key updates and some potential ways PCNs can work towards achieving them.
This year provides more detail on the role of PCNs within INTs. This is formally defined within contract documents as a requirement to ‘collaborate with non-GP providers to provide better care, as part of an integrated neighbourhood team.’
Included under a PCN’s ‘four core functions’, organisations are to play an important role in not only forging links between practices, but also the system as whole. This means working with partners in the community as well as the voluntary sector, and sharing responsibility to support health and wellbeing at scale.
It’s clear that the legacy of the Fuller Stocktake continues to grow, with the concept of neighbourhood teams building ever more momentum. Indeed, here at Suvera, we have seen much of this work is already taking place from collaborating with our PCN partners. But it is certainly welcome to see it included as a key function within the Network DES for the first time.
PCNs will continue to focus on reducing health inequalities in their footprint, taking a population health approach in line with CORE20PLUS5.
However, a more prominent role is given to the enabling function of data and analytics within this context this year. This includes leveraging data to target care and improve outcomes in populations, and working with partners such as community pharmacy to identify and manage risk. In regards to the latter, clinical focus areas include hypertension case finding, optimal lipid management, respiratory diseases and earlier cancer diagnosis, to name but a few.
One way PCNs can adopt a data-driven approach to case finding is through virtual clinics. PCNs working with Suvera have adopted this model to support with risk stratification, outreach and early identification, managing patients living with chronic illness remotely. Taking hypertension as an example, PCNs have attained over 80% QOF target achievement across practices.
Changes to ARRS include the addition of enhanced nurses as a new role and the removal of caps on other patient-facing positions, providing more flexibility.
PCNs are required to ensure appropriate ARRS capacity and allocate funding accordingly. This also includes Capacity and Access Payments which now encompass three indicators previously from the Investment and Impact Fund. Capacity and Access Payments are to also fund Modern General Practice Access models.
The focus on ARRS reflects ongoing capacity challenges, and at the same time, indicates the success of the scheme in alleviating some of those very same demand pressures. PCNs can continue to play a key role in building resilience and helping practices leverage the benefits of working at scale through ARRS. Indeed, calling on shared digital resource through the scheme is one of the core ways partners work with Suvera. And with any unspent funding taken away this year, making the most of ARRS will be more important than ever.
Included under ‘targeting resource’, PCNs are tasked to deliver ‘multidisciplinary proactive care for complex patients at risk of deterioration and hospital admission.’ This workstream also forms part of working within an integrated neighbourhood team.
Again, risk stratification is highlighted as a key means to prevent ill health and PCNs should utilise structured medication reviews for patients at risk. Other medicines optimisation measures noted include reducing polypharmacy, risk of prescribing harms, over-prescribing as well as increasing social prescribing. The development of enhanced health in care homes services is also noted. Finally, PCNs should seek to collaborate with non-GP providers to help manage the health and care needs of the populations they serve.
Suvera is working with PCN partners to achieve goals in many areas highlighted by this year’s contract. We deliver proactive care to at-risk patient populations living with long-term conditions and can support with case finding, risk stratification and prevention.
Our virtual clinics increase chronic care capacity at scale. While our digital tools and care teams support multiple practices with structured medication reviews and ongoing management to keep patients in good health.
To find out how we can help you, contact our team on partnerships@suvera.co.uk.
Discover how we helped Shrewsbury PCN in our case study film.