Why nhs reform

Hugh Alderwick. Long read. Integrated care. Primary care. What are the implications for PCN leadership and the voice of general practice? Are PCNs mature enough to withstand the changes ahead?

What conditions are needed for PCNs to work within the new proposals? Considerations for NHS leaders. The changes aim to support NHS organisations to collaborate to improve care and manage resources, and may mean the abolition of clinical commissioning groups CCGs and new area-based agencies being established.

This long read explores five key questions that the proposals raise for the future of primary care networks PCNs in England. We discuss the conditions required for PCNs to find their place within newly established integrated care systems, while continuing to develop and strengthen local primary care.

PCNs have the potential to improve quality of care — and early evaluation shows that PCNs have made good progress in getting services under way in a challenging context. But there is a risk that too much is being expected of PCNs too soon. The proposed changes could cause disruption for PCNs and risk diverting them from their core goals of improving integrated care and the sustainability of primary care. At worst, system reform may destabilise these fledgling networks.

Adequate PCN representation on new integrated care system boards will be essential if the proposed changes are to achieve their goal of enabling better integration between primary care, acute hospitals, mental health, community and social care services.

Making sure that the voice of PCNs and primary care within integrated care systems is fair and representative will be challenging. Clinical directors of PCNs will need to invest time in building relationships with the commissioning and support systems that emerge after CCGs. There is a risk that PCNs may be drawn away from their focus on delivering care at a smaller neighbourhood level, and working to shore up general practice for the longer term.

Primary care buy-in to integrated care systems will be essential if the proposed changes are to achieve their goals. The NHS is good at developing new initiatives, and less good at nurturing them over the longer term. New primary care organisations should be enabled to grow organically, focus on local priorities, mature, and develop a true sense of local ownership. Download PDF. How will changes to clinical commissioning groups affect PCNs?

To help address the risks described here, NHS leaders should consider the following as they further develop their plans for new NHS legislation over the coming months: PCNs will need to work together to identify the needs of primary care within integrated care systems and how they vary depending on local context.

System-wide priorities must be balanced with the need to support locally-led changes by PCNs and their partners. Governance and decision making within integrated care systems should be inclusive and flexible enough to allow fair representation of all PCNs. This means developing mechanisms to avoid the risk of more mature PCNs dominating decision making, or variations in local context for PCNs not being recognised in system-level planning.

Clarity is needed on how much control integrated care systems will have over PCN budgets and decisions or how the level of control will be determined by local systems. This includes defining which organisations are accountable for which population health needs, as well as the support given for any expansion of PCN responsibilities.

Time and resources will be needed to support relationship building between PCNs and integrated care systems, particularly where there are currently strong working relationships between PCNs and CCGs which may be lost in the new arrangements. The intended benefits of the new arrangements should be clearly articulated to PCN leaders and local primary care teams. A nuanced approach to measuring and monitoring the progress of PCNs within integrated care systems should be developed, allowing flexibility for PCNs to address local needs alongside broader system goals.

Further reading Briefing. Understanding primary care networks July The government must engage meaningfully with all partners across the health and social care system, especially with local authorities, to clarify its position alongside NHS service providers within the reformed system.

Contact Kerry McQuade. Theme System working Population health Regulation and oversight Workforce. Publisher NHS Confederation. Related content. As a result, the health secretary, as part of these changes, will regain some of the powers that were passed over to the NHS years ago. The temptation to take control is clear, particularly in the current circumstances. But one former minister warns of a two fold risk: "You can't run the system from Whitehall and it's politically foolish.

He'll end up with every problem on his desk. The defenders of the changes point out that the solutions being espoused have changed because the health service's problems have changed. When competition and choice were the mantra, the NHS' problem was lengthy waiting lists. Private sector efficiency and competition was seen as a way of driving them down. Now the issues of demand and an ageing population means the gap between health and care is becoming smaller and smaller.

With pressure on budgets too now, one source said: "The pressure isn't to compete, it has to be to collaborate. Despite some of the rhetoric around, however, the changes outlined on Thursday do not provide a long term solution to how we care for the elderly. Espousing more working together between doctors, social care and councils could help, but it is not the big answer to the problems laid so bare during the pandemic.

That solution is still promised, but still some way off. There will be changes to the NHS in England that will make a difference to how one of the most important organisations in the country is run. The government will, in law, correct what many see as the mistakes of a decade ago - formalising some changes that have already been made in practice on the ground. If you do not want a market system and you want to run a public service, you need a different form of legal structure.

The case for it is as strong as ever. Peter Roderick , principal research associate, Newcastle University. Allyson M. Pollock , professor of public health, Newcastle University. We welcome submissions for consideration. Your article should be clear, compelling, and appeal to our international readership of doctors and other health professionals.

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