General Practice Transformation Champions, 28th March 2019, Novotel Hammersmith, London

1. Walk Before You Run
Getting the Foundations Right
Primary Care Networks
David Ainsworth
Director of Primary Care
Mid Nottinghamshire CCGs

2. Context of the environment
• Two CCGs – single executive team. Moving to six CCGs – single
executive team.
• Population size: 350K.
• One large acute teaching hospital; two community hospitals; one self
care hub.
• Higher than national average levels of deprivation, amputations from
diabetes, smoking at time of delivery.
• 40 GP Practices; rural and inner city mix
• CCG in financial turnaround for two consecutive years.
• Higher than regional average number GPs and Practice Nurses
approaching retirement age.
• Vanguard area with high levels of transformational success.

3. Mid Notts Provider Alliance
• All seven providers signed an MoU.
• Developed system solutions for wicked problems.
• MSK – First contact practitioner/triage.
• End of Life.
• Community single point of access – guaranteed two hour
response.
• MDT risk stratification.

4. The New Five Year GP Contract
• National DES scheme - a member of a primary
care network:
− Workforce.
− The indemnity solution.
−The creation of Primary Care Networks.

5. Some simple facts
• Placed based care provision; organisation agnostic.
• Focus on population health in places of circa 30-50K.
• ICS 1m Popln.
• ICP 300-500K Popln.
• PCN 30-50K Popln.
• Greatest opportunity for GPs since 2004.
• Patients should truly get more care closer to home.
• Prevention, self care and social prescribing front and
centre.
• Not just about GPs but it’s all about GPs.

6. Quick Thought
If you want PACE – work alone.
If you want SPREAD – work together.

7. Key foundations of working in place?
• 100% population coverage.
• Inter-practice referrals.
• Core Plus.
• Delivery vehicle
• Signed MoU

8. Be flexible and adapt so that you strike the balance
Quick Thought
Top Tip:
Creates local
ownership and
reduces
suspicion

9. The formation of PCNs is key
• Six PCNs – operating PCN contracts covering 100%
population including:
- Extended Seven day appointments inc. bank holidays.
- Wound Care.
- 24hr ECG.
• Provide the key to unlock system problems - They provide
the ‘HOW’ to the ‘WHAT’.

10. Newark PCN 77k Popln; 7 Practices
34 Southwll MC
35 Lombard MC
36 Barnby Gate
37 Fountain MC
38 Balderton PCC
39 Collingham MC
40 Hounsfield
A CAB
B Social Care Clinic
C Continence Clinic
D Leg Ulcer Clinic
34
35 36
37
38
39
40
AC B

11. Sherwood PCN 60K Popln; 7 Practices
27 Sherwood MP
28 Major Oak
29 Middleton Lodge
30 Bilsthorpe
31 Hillview
32 Rainworth PCC
33 Abbey MG
A CAB
B Older Adults Clinics
C Occupational Therapy
D Continence Clinic
E Leg Ulcer Clinic
27
2
29
30
31
32
33
D
E
A
C
B

12. Mansfield PCN MN: 58K Popln; 8 Practices
MS: 47K Popln; 5 Practices

13. Ashfield PCN AN: 52K Popln; 5 Practices
AS: 39K Popln; 8 Practices
1 Jacksdale MC
2 Selston
3 Ashfield House
4 KCPCC
5 Lowmoor Road
6 Family MC
7 Kirkby HC
8 Health Care Complex
9 Woodlands MP
10 Brierley Park
11 Willowbrook MP
12 Skegby Family
13 Kings MC
A CAB
B Occupational Therapy
C Older Adults Clinics
D Social Care Clinic
E Continence Clinic
F Leg Ulcer Clinic
Ashfield
1
2
3
4
5
6
78
9
10
11
12
13
ABC
EF
D

14. Phase 1: Live Services
• Acute Home Visiting Service.
• Care Homes Services.
• Specialist Nurse Clinics.
• Community IV service.
• First Contact Physio.
• Social Workers co-located with localities.
• Notts Connect (Age UK).
• GP Core Plus Enhanced Services Locality Hub Navigator.
• Secondary care services in the community.

15. Latest progress – Phase Two and beyond
Phase 2 – Quarter 4 2018/2019:
• IAPT based around PCNs.
• High Volume Service User workers.
• Local Authority – Housing Benefit Officers, Signposting to
services.
• Maternity Hubs.
• Dental Services.

16. Quick Thought……
You still need sustainable CORE
general practice for PCNs to be
successful

17. Practical Must Do’s
1. Sort your structure
Establish and sign up your PCNs – National DES.
2. Make sure governance is transparent to all
Avoiding suspicion and building trust/confidence.
3. Sort your people
Lead roles; representation; wide engagement and comms.

18. What you need to do next

19. National DES Sign Up
Six factual pieces of information:
(i) the names and the ODS codes of the member practices;
(ii) the Network list size, i.e. the sum of its member practices’
registered lists as of 1 January 2019;
(iii) a map clearly marking the agreed Network area;
(iv) the initial Network Agreement signed by all member practices;
(v) the single practice or provider that will receive funding on
behalf of the PCN; and
(vi) the named accountable Clinical Director.

20. CCGs are responsible for confirming that the registration
requirements have been met by no later than Friday 31 May 2019.
• The CCG must secure an explicit pledge of support from the
leadership of the local Integrated Care System/Sustainability and
Transformation Partnership.
• Rather than approve each Network Contract one at a time, all the
Network Contracts within a single CCG will be confirmed at the
same time.
• Once the registration requirements are met and GMS/PMS/APMS
contracts have been varied to include the DES, the Primary Care
Network can start receiving national investment from 1 July
2019.
National DES Sign Up

21. Principles of an effective network
• Clarify a shared purpose – what can we do together that we can’t
do on our own?
• Equal peer relationships based on reciprocity.
• Requests and offers are dynamic.
• Actively seek diversity? Are you engaging widely enough?
• Clear rules of engagement.
• Peer working and review.
• Member resourcefulness and mutual trust.
• Try things out interactively.
• Share knowledge.
• Amplify effectiveness of individual members?
• Rapid learning and development.

22. List of your jobs to do……..
• Nominate your clinical director.
• Agree who will hold the central PCN fund.
• Develop a shared vision.
• Develop relationships with community teams, social care, voluntary
sector, acute providers.
• Agree how you will speak with one voice.
• Ensure you have an appropriate representation at ICS/ICP.
• Ensure you have ways to communicate and cascade information
through PCNs.
• Hold engagement activities to engage the wider workforce.
• Engage with patients and the public.
• Map each PCN ingredients – estate, workforce.

23. My snag list (is growing….)
• Training hubs/PLT.
• Links with education.
• Links with community safety partnerships.
• CCGs transition to new commissioning arrangements.
• Finalise nursing leadership.
• Ensure AHP leadership is covered.
• CCG resource in kind.
• Social prescribing, physiotherapist plan.
• National team to leave you to get on with the job in hand and trust
local areas to assure delivery through ICS.

24. Change Management Theory into Practice

25. Let us keep talking
Feel free to make contact:
David Ainsworth
david.ainsworth@nhs.net