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As part of a new series on the emerging primary care networks, we spoke to East Cornwall PCN clinical director Dr Penny Atkinson to find out what her team is hoping to achieve
East Cornwall primary care network (PCN) is on the larger end of the network population scale, caring for 105,000 patients across nine practices. It is situated in a rural region scattered with market towns, and with many patients living in deprived areas and presenting several healthcare challenges. But as Dr Penny Atkinson, GP and PCN clinical director, says, collaboration is key to meeting these problems head on.
Dr Atkinson has been the lead GP chair for the whole of East Cornwall for two years, the lead for the three primary care home areas and is now the clinical director for the East Cornwall PCN. Like many PCNs, collaboration between practices across East Cornwall was already mature before 1 July, with a board of directors and several connections with community services already well established.
‘When the PCN started, we talked at length. We thought: “Do we create another layer of bureaucracy and management or do we use that existing footprint?” We are quite unique – we’ve got an overarching umbrella with the old locality footprint, but we have then divided that up that PCN into three neighbourhoods, that have around 30,000 patients each, which works quite nicely really,’ says Dr Atkinson.
‘We collaborate and work as one. We’ve hopefully removed a lot of the unnecessary layers that could have detracted from what we’re trying to do. We can work at scale, but our strength is that we can also be really bespoke for the different practices.’
Making a difference
The East Cornwall PCN has made several improvements in its short lifespan. It has prioritised IT solutions through the merger of five practices’ medical record systems and the promotion of useful apps as management solutions for patients and a low carb app for those living with diabetes.
Each of the three neighbourhoods within the PCN has its own clinical lead, and all serve varying patient needs. Recognising these differences and working to address them has required significant changes in structure, as well as bringing in allied professionals to lighten the burden that GPs are facing.
The PCN has recently recruited clinical pharmacists already working in local practices and a hiring process is underway to bring in more social prescribers, strengthening an already successful model. However, one addition that has been quickly successful is a first-contact physiotherapist.
‘We’ve had our first-contact physiotherapist up and running well over 12 months now and that’s been really exciting. First-contact physios are very experienced physiotherapists and they are already working within the system, so we’re deliberately not stripping out anything that is already there. Each practice has them for a day or two days a week,’ explains Dr Atkinson.
‘This is direct GP resilience. The physios will have patients triaged to them or directly booked with them who the GP would normally see. Somebody with acute back pain or knee pain, they will see them and treat, advise and then discharge on to community physio or to secondary care. The whole point is that would have been a GP appointment. The data has been really positive on reducing the load on community physiotherapy because those people are being seen appropriately, treated, advised and [discharged]. It has an impact on the whole system.
‘There are so many things that we’ve done, and some of them are low-hanging fruit and some are broader changes. But the underlying core value is looking at GPs and primary care resilience, but also molding it into what the PCN requires. The two compliment each other.’
Keeping in contact
A lot of communication is needed to maintain these relationships between practices and professionals, as well as with the wider community. There are monthly board meetings and biannual summit meetings, where all new starters are invited to attend. From reception to allied health professionals, all are welcome to feed back and put forward their priorities.
Dr Atkinson highlights that mental health issues are a big focus for her PCN as it is an area becoming more and more prioritised across the country. Again, everything links back to collaboration and communication to keep the network active and effective. Whether that’s working with the community, other health organisations or bringing in more allied health professionals, without a strong relationship, patients won’t receive the potential benefits that all these bodies can bring.
‘A big priority for us is mental health in primary care. We’re working closely with Cornwall Foundation Trust to have embedded staff that don’t do secondary care work, we’re making sure that what we’re doing is the right way of doing it. We are looking at best practice in other parts of the country where it is working well, and it’s not just the challenge of getting staff like pharmacists and paramedics and we’re really aware of that, one of our priorities is to collaborate with them.
‘I think portfolio careers are really important so that we can attract staff and smaller practices can get some of that new workforce as well. That for me is the real beauty of working at scale. We can give smaller practices a clinical pharmacist’s time, a paramedic’s time, some social prescriber’s time and on their own they could never do that.’
While bringing in new staff, integrating new technology and strengthening bonds are important, Dr Atkinson realises why these measures are also important to existing staff. Resilience and wellbeing are hugely important as shortages continue to plague primary care services and giving staff some time in the day when the pressure is lessened can be hugely beneficial.
‘I’ve learned the value of giving our people some headspace in the last 12 months. We’ve got a big focus on the PCN development to overlap with the development matrix, but we actually want to get our organisational delivery right and look at proper systems leadership. Getting that right for us is really important,’ says Dr Atkinson.
‘For me, building trusts and relationships is the most important thing, it’s our mission to do that and make it a place people want to work and want to be and feel valued.’