Get to know your neighbours (or you face a lonely struggle)

Emerging Primary Care Networks will be expected to deliver ‘locally agreed action to tackle health inequalities’ by 2021. The good news is they don’t have to do it alone.

Merron Simpson, CEO of Health Creation Alliance explains the opportunity awaiting PCNs and General Practices that reach out to local and community partners in the task of addressing inequalities.

@merronsimpson

The advent of Primary Care Networks in the 2019 NHS Long Term Plan marked the moment when General Practice officially gained a ‘system’ around them.

Operating as small businesses contracted by the NHS, a mixture of financial, regulatory, clinical and administrative drivers has led practices to self-organise in recent years into federations, networks and super-practices. General practice ‘at scale’ has increased the capacity of practices to deal with the more strategic demands facing modern practices. This organic coming together of practices around patient populations of 30-50,000 have paved the way for Primary Care Networks (PCNs) and most practices are signing up.

Local partners operating outside the NHS are both relieved and frustrated by this new development: relieved at the potential to engage with primary care at a systems level and frustration that the PCNs have adopted a different administrative neighbourhood footprint that doesn’t reflect either the ‘real’ neighbourhoods, the way that communities experience them, nor local authority neighbourhood boundaries. This presents a conundrum for councils who are keen to connect with health and at the same time to maintain the flow of their own transformation programmes. Greater Manchester Combined Authority, has squared this circle by undertaking a wholesale reorganisation of their neighbourhood boundaries around these PCN populations in order to smooth the way for more integrated working. The fact that it hasn’t managed to do this across all ten of its localities is testament to the difficulty and disruption it has caused.

PCNs are focused on delivering 7 nationally set specifications. But they need to give equal focus to developing relationships with the raft of new partners on their doorstep, including communities themselves, if they are serious about the reducing health inequalities (the 7^th service specification). Health Creation is all about relationship; it is about recognising, building on and connecting the strengths – people, networks, organisations – that already exist in a place and nurturing the energy and action that emerges. It’s about working with the grain of existing efforts and seeing communities as part of the system, not separate from it. This point was made loud and clear by delegates at a recent event hosted by Health Creation Alliance and Royal College of General Practitioners’ Health Inequalities Standing Group.

This is wholly different from how the NHS is used to working. And given the pressure on primary care it is a big ask. But a handful of places have made the shift and are paving the way for highly effective partnerships to emerge. This includes Dr Vikesh Sharma, a Stockwell based GP who has, over the last 4 years, devised new ways of working to improve the wellbeing of the Portuguese-speaking community. Speaking about this work, Vikesh says that his role has been largely as an enabler and advocate, explaining to his health colleagues what it is his community-based colleagues are doing and why it’s working. It also includes the Alvanley practice in Stockport which has developed Practice Health Champions who help to connect community members to each other and support them to take action that is both fun and that serves the needs of the community well. At the PCN level, it includes Modality that has employed a community development worker to help to broker connections between general practice-based staff and local communities.

Models for developing this community-based working as a vehicle for improving population health and reducing health inequalities are emerging. Health Creation Alliance is hosting a further series of events, with a wide range of partners and supported by NHS England and NHS Improvement, to shed more light on how Primary Care Networks can best work to succeed in reducing health inequalities. As well as unearthing new models, we hope to answer questions such as: What skills are required to bring practices, communities and local partners together? What needs to happen to prevent link workers from sinking under the strain of expectation? How can PCNs work effectively within wider public sector reforms taking place? What should the 7^th service specification contain?

We are asking delegates to come with a ‘discovery mindset’ because unless we find some solutions to these questions then nothing much will change; primary care will continue to struggle and the huge contribution it could make to population health and a better functioning healthcare system overall will not be realised.

Link to July 19 event report: https://www.thehealthcreationalliance.org/wp-content/uploads/2019/10/PCNs-conference-report_3.0.pdf

Link to the July 19 event video: https://www.youtube.com/watch?v=md_bCY_vKB0&feature=youtu.be

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