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10 top tips for PCN clinical directors - The respiratory long term condition perspective

How one Long term condition might be used to fulfil the potential of PCN investment

PCRS Service Development Committee member, Stuart Shields, has written "10 top tips for PCN clinical directors - The respiratory long term condition perspective"  to support Primary Care Network clinical directors working to improve local respiratory services.

1. Vision

A primary care network consists of groups of general practices working with a range of local providers, across primary, community and social care, and the voluntary sector, to offer more personalised, coordinated health and social care to their local populations. https://www.england.nhs.uk/gp/gpfv/redesign/primary-care-networks/ Don’t lose sight of this. Your PCN should not try and do anything without help from allies.

2. Analysis

Primary care has a lot of live data; use it to plan where to make improvements in pockets of poor outcomes. You do not have to do it yourself – you need to ask your health informatics dept and use https://www.england.nhs.uk/rightcare/workstreams/respiratory/. Your CCG have informatics resources for your use.

3. Scenarios

Discuss what needs to be done to improve respiratory care within your PCN – you all know what needs to be done. Choose the scenario that addresses what you think needs to improve Respiratory care in your locality.   www.pcrs-uk.org has examples of best practice.

4. Options

Who is going to deliver the changes? - will it be a motivated primary care team working across practices? will it be a collaboration with a community provider? Will secondary care come out and work in your locality? Will any options become slowed down by contracting and commissioning? Chooses an option that will deliver most of your expectations rather than one that is too good to ever happen.

5. Legal Implications

You are going to be sharing data, accessing records, prescribing and treating respiratory patients on behalf of the group. Run your option through a “what if” table top exercise, invite critical friends in to try and “break” it. Learn and adjust.

6. Policy and Strategy

There are national Strategies for Respiratory Care. They are both clinical and environmental. Map them against your population from pre-conception to “end of life care”. These Strategies direct other providers and agencies. PCRS has done some of the work for you.

7. Resource

You should now have an idea about what resources you need, and what is available for your chosen option. You could make a case for investment if there is a gap. Patient groups are vital, don’t plan without them as they will be your data when you demonstrate a reduction in smoking/admission/ED attendance rates.

8. Planning and Doing

The PCN contract does not give you a lot of time. You cannot deliver this alone. Each member practice is already delivering respiratory care; choose the best performing practice  and ask them to share their methods to help the locality – your aim is to assure that it reaches the whole population, consistent, fair access to sustainable primary care.

9. Policy Performance

Your respiratory performance data is mostly generated by QOF and this can be collated live. Your patient groups can be involved in reported experiences. Consider delegating patient experience data to your patient groups.. 

10. Evaluation

The PCN programme will change year by year. Social prescribing, pharmacists, physiotherapists, paramedics, improved access appointments – will all be part of the investment- and when the question comes “but what did they actually do?” – your respiratory care plan will answer that question, start with the end in mind. What matters? Are there already some prioroties illustrated by your PCN group – in which case ensure outcomes are aligned with this.

Good quality life? Minimal emergency admissions? Medication used well with minimal waste? And the least number of clinical hours to achieve all your aims. These are either being measured, orcould be measured from the beginning.

Stuart Shields
Clinical resource or information
PCRS Produced / Collaboration
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