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Primary Care Networks - Draft Service Specifications - Part 2!

The next few weeks will be crucial in determining the future of the seven service specifications and even PCNs themselves.

  • 27th January 2020

In a nutshell

1

The next few weeks will be crucial in determining the future of the seven service specifications and even PCNs themselves.

In part one of this article posted earlier this month, the spotlight was on the initial two services specifications which need to be delivered in full commencing April 2020. It also highlighted a few positives and negatives of the draft document. Presently, there appears to be a lot of negative press about the draft PCN service specification document, and some doubt about its future. In this article we will shed some light on the three remaining service specifications which will/may be phased in over the next few years beginning April 2020.

The anticipatory care service aims to help people live well and independently for longer and has the laudable target of people enjoying at least 5 extra healthy independent years of life by 2035.

To help achieve this, in the coming months primary care networks (PCN) need to establish clinical leads to coordinate this service and identify patients who would benefit from this service.

Currently, there is no standardised approach to identify individuals for this service. Therefore, in the first year, networks will need to establish their own registers. Over the past year or so, practices have already been developing frailty registers using a combination of the electronic frailty index and clinical judgement. It is more than likely that most patients who will benefit from this service will come from practices severe and moderately frailty indices.

Relationships between providers are paramount in this service, as the clinical lead will need to develop and establish clinical accountability and governance arrangements with the multiple providers involved. This is where CCGs can help support PCNs with the coordination of these meetings and establish data sharing agreements.

On top of these initial meetings, regular multidisciplinary meetings need to be scheduled so that the coordination of care and the development of the service can be carefully monitored and progressed.

Following this, the clinical lead will need to establish a ‘network wide’ needs assessment criteria. Practices will have their own specific needs assessment criteria; however, it would be of benefit to pull these together into one cohesive standard for the network. Then the creation of data collection templates/reports will need to be developed, as well as training on the templates, so that all providers involved contribute to the quality of the data gathered.

The data which is gathered in the first year will undoubtedly help support the development of public health management tools, so that in following years sufficient data will be available to predict and identify patients who are at risk, and identify particular interventions that would support them to remain healthy.

The personalised care service specification allows individuals to have choice and control over the way their care is planned and delivered based on what matters to them.

This service also requires a clinical lead who will be responsible for the service across the network.

The service seeks to increase the number of personalised care plans for a specific cohort of patients. In the initial year, patients who will be a priority for this service are patients who are in the last 12 months of their expected life span, and who are eligible for the anticipatory care and enhanced health in care homes. However, networks may wish to include further cohorts including people with multiple long-term conditions, or who are at risk of hospital admission or diagnosed with cancer.

This service includes several targets. For example, in the first-year personalised care and support plans need to be in place for at least 5-10 patients per 1000 weighted population, and 4-8 referrals per 1000 weighted population to social prescribing providers such as primary care navigators or social prescribing link workers.

Personalised care and support plans may not be a new concept to some practices who have implemented or who are familiar with the ‘year of care’ model of delivering chronic disease management. This model, mainly delivered by nursing staff, allows patients to take ownership of their health and, working with the clinician, allows them to set their own goals and areas they wish to focus on. Potentially, much of this service could be delivered by the same nursing staff who are familiar with concept of personalised care and goal setting.

In the following years, the service will develop to include higher targets for personalised care planning and social prescribing referrals along with the further promotion of personalised health budgets and an increase in the shared decision-making criteria.

The supporting early cancer diagnosis service has the objective of increasing the diagnosis of cancer at an early stage to around 75% of patients. This will mean that more people each year will survive their cancer for at least 5 years after the diagnosis.

NICE guidelines number 12 covering suspected cancer recognition and referral, sets out the actions for this specification: namely, to improve referrals, screening uptake and reflective practice. Most practices are already engaged in implementing these actions, so it is up to the clinical lead to support the clinical best practice at a network level.

Improving the referral process across the network can be done by analysing the network level data to identify and proactively manage local trends, sharing good practice and significant event analysis across the network, discussing the referral with the patients as well as providing patient information leaflets and safety netting patients are all included in improving the referral process.

Another focus of this service is to improve the screening rates for the National Cancer Screening Programmes as well as any local screening programs. This could be as simple as reviewing the results or correspondence and having a clinician contact the patient by way of a phone call or letter to try and encourage the patient to engage with the screening programme; for example, if the patient did not attend their appointment, did not responded to the invite letter, or failed to return the testing kit to the screening provider.

All the above should be tidied up nicely in a network level screening improvement action plan, which will detail the actions to be carried forward to 2021/22. The action plan should show that the network can continue to deliver and increase the uptake of National Cancer screening programmes, improve the quality of the referrals which the practice makes, and also add to the clinical knowledge base by way of reflective learning, through sharing good practice and also significant event analysis at a network level.

Overall, the aspirational aspects of the document are to be praised. However, a lack of detail and questions over workload and funding may deter many PCNs from implementing the services outlined in the document, and even calls into question the validity and sustainability of the PCN model.

The next few weeks will be crucial in determining the future of the seven service specifications and even PCNs themselves.

Jonathan McCutcheon

Jonathan McCutcheon

Practice Management Consultant

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