Primary Care Networks: Friend or foe for GP practices on the fringe? (Part 2 / 2)

posted 29 October 2020

These are hard times for everyone, but particularly for our healthcare professionals. For those in general practice, COVID-19 arrived on the immediate back end of a major reorganisation as primary care services came together to form more than one thousand Primary Care Networks (PCNs).

Fast forward one ‘unprecedented’ year, and the demand placed on fledgling PCNs throughout England is growing. PCNs face not only a backlog of routine health appointments and badly managed long-term health conditions, but also an increase in other complaints including mental illnesses and the management of “long covid”.

With flu season on the horizon and COVID-19 cases once again on the rise, our newly formed networks are expected to play an essential role in the system’s response to the second wave, but is it a fair fight?

In this two-part blog post I will explore the effect of this nationally prescribed change to service delivery on the funding and workforce of very rural surgeries and those operating in urban areas of high deprivation. In this second contribution, we will focus on the unique challenges and opportunities for PCNs operating in our cities.

Part two: PCN in the city

Compared to their rural relatives, general practices in our cities and towns are well placed to benefit from working at a scale, particularly those practices who were already ahead of the curve working in partnership as part of GP federations or Primary Care at Home systems. These practices will likely adjust more quickly to the new system and benefit from new funding and performance payments. But is this true for all practices operating in built-up areas? Probably not.

Consider that 12% of England’s urban population live in the top 10% of deprived areas (compared to just 1% of the rural population11) and you may begin to see the issue.

Source: Ministry of Housing, Communities and Local Government (MHCLG)11

People living in areas with greater income deprivation are more likely to have a range of debilitating health conditions, such as chronic lung diseases, serious mental illnesses and diabetes . There is also strong relationship between deprivation (measured locally) and healthy life expectancy at birth. Put simply, the poorer the area, the worse the health, and the greater the demand placed on local healthcare services.

So what do PCNs mean for general practices serving these communities? Let’s take a look…

 

Workforce

In 2017, the total number of GPs employed in the top 20% of deprived areas fell by ~500 GPs, while the wealthiest 20% experienced a ~100 GP boost to their numbers. This statistic captures a worrying trend for new GPs to prefer positions in less deprived areas.

Fortunately, forming partnerships with other practices in the local area may help to combat workforce shortages.

As part of a PCN, each practice will gain access to a greater number of healthcare professionals across a wider geographic area, including an anticipated army of allied health professionals! As with rural networks, urban PCN may find it easier to meet demand by embracing the multidisciplinary primary care team promoted by NHS England.

 

Funding

Since 2004, the global sum allocation formula, or Carr-Hill formula, has been used to weight funding for GP practices, despite concerns that this formula does not adequately adjust for deprivation.

Controversially, the latest DES contract continued to apply this formula and furthermore the additional funding offered to incentivise GP practices to form PCNs (£1.50 per patient) is not weighted at all.

As a result, primary care networks in areas of high deprivation will receive disproportionately less funding with which to address the complex needs of their communities.

 

The verdict

PCNs are well placed to benefit both rural and urban communities; however, imperfect implementation could propagate pre-existing inequalities in deprived areas. With the second wave upon is, additional care must be taken to consider the impact of deprivation and health inequality on local services to ensure those on the frontline have adequate support and funding to meet the demand.

As it stands, processes for distributing funds between practices can lead to practices receiving funds insufficient to their needs and PCNs in areas of high deprivation are likely to benefit the least from PCN funding allocations.

However, PCNs comprised of varied demographics present an opportunity for better place-based thinking, and the option to allocate funds sensitively taking into consideration the demands placed on each practice. With pandemic shining a light on the devastating effects of inequality on health outcomes, now might be the time for PCNs (and STPs and CCGs) to think about how we can serve our communities more fairly.

 

References

  1. commonslibrary.parliament.uk/health-inequalities-income-deprivation-and-north-south-divides/ 
  2. www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on/the-marmot-review-10-years-on-executive-summary.pdf
  3. www.kingsfund.org.uk/blog/2019/05/primary-care-networks-deprivation-challenge
  4. www.pulsetoday.co.uk/news/practice-personal-finance/ccgs-sitting-on-millions-in-unspent-funds-for-gp-additional-roles/
  5. www.bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/contracts/gps/focus%20on%20global%20sum%20allocation%20formula.pdf?la=en
  6. www.kingsfund.org.uk/blog/2019/05/primary-care-networks-deprivation-challenge