How many people in our population know about primary care networks? I suspect it is remarkably few although they are a policy choice which will radically alter service provision. Ultimately, they are just one more step towards England having an American-style healthcare system. Nobody told the public about primary care networks. Nor were they given a choice about whether they want them. The truth is hard to sort out amongst all the spin attached to their introduction. In this post we will attempt to explain what these new bodies are all about.
The background
Successive governments have brought in policy changes which have beem incremental steps towards complete marketisation. Thatcher started the process after saying that privatising the NHS would be political suicide. But she started a process of successive changes that would lead to that end without any backlash from the public. You can read about the strategy for privatising the NHS (and other public services) in the Ridley Plan published in 1977.
This process continued under every Government since Thatcher but has rapidly accelerated since the introduction of the Health and Social Care Act 2012. We must judge policy decisions by what happens next and where our NHS is heading. And primary care networks are no different.
A Primary Care Network (PCN), is one of the building blocks of an Integrated Care Systemn(ICS) or Accountable Care Organisation (ACO). The term accountable care became toxic when the public realised what it meant so they changed the name. America designed the concept of integrated care as a means to restrict access to treatment. In the US the last thing insurance companies want is massive bills every time people get ill. Nor did the US Government want to end up saddled with huge bills for the people they covered with Medicaid. These decisions are solely financial and not based on patient need at all.
Groups of GP practices who agree to work collaberartively will form a PCN. Funding is shared between practices and each PCN will be given additional funding to recruit staff with other roles. This could be nurses, physios, paramedics, pharmacists and mental health professionals. GPs have a choice on whether they sign up for a PCN or not. It sounds good really or does it…
The reality
In the UK we have starved GP practices of funds for a long time. GPs have been left frustrated by the difficulties they have when trying to get a patient treatment. They have always worked very hard but they used to have job satisfaction. As cuts took away the job satisfaction many GPs left the service. The recruitment of GPs has been lagging behind the numbers retiring or leaving the profession. As additional funding is only available for GPs who sign up to a PCN many felt their hands were tied.
Lesser qualified professionals will soon be replacing your GP whenever you seek help. The work of a doctor will be more about overseeing the work of these people. Many feel this is an inherently unsafe approach that will also lead to even less job satisfaction for GPs and hence even more will leave the service. Watch this interview with campaigner and working GP Dr Bob Gill about what is happening to primary care.
Many of these PCNs have already opted to have new buildings constructed such as the Victoria Medical Centre in Eastbourne and the St Leonards Medical Centre in St Leonards-on-sea. Practices in the network can operate under one roof in these hubs with space for the other roles they have recruited. Gone will be the days when our GP surgery was based close to our homes. The elderly, disabled and young mothers will suffer more from this change than their healthy counterparts. Gone will be the days when we will get to know our doctors and they get to know us. Our own safety will be compromised as we wave goodbye to the family doctor who knows us as indviduals. Those with complex conditions and mental health problems will be fare far worse than others.
But did we ever need these changes to occur? Many have hailed PCNs as a solution to the problems occuring in GP recruitment. But it seems likely that they will only lead to greater problems as they further destroy job satisfaction for GPs. If instead our NHS had stopped the cuts, the privatisation and wastage of endless ‘reforms’ then perhaps GP numbers would have started growing again?
NHS England expected GPs to make very quick decisions about joining a PCN in the first place. They also expected them to offer many services previously provided in hospitals once in a network. Although this expectation would eat into any additional funding they recieved. But with practices barely able to keep themselves afloat its not surprising many agreed.
Where do we go from here?
It has been hard to get all this information as the internet is full of spin and propaganda about PCNs. In the same way our CCG gave us little more that spin and propaganda when they talked about closing the Eastbourne Station Health Centre. Surely our population deserve more than this? How have we reached a point where the public are only fed propaganda about changes to the NHS they are so proud of? More importantly how do we get back to the point where democracy exists and politicians will aim to provide decent healthcare for all?
Would you help us fight for the restoration of a publicly owned and accountable healthcare service that is free at the point of need?
