In many parts of the country it appears that younger GPs are often those that have stepped up to the role of clinical director, perhaps because they come with a fuller charge of energy and transformational zeal.
While it may be true that older GPs may feel that with a few years left until retirement, taking on the leadership of a primary care network (PCN) is a job too far, there are some exceptions.
David Roche, a GP for 30 years and a board member of his CCG until next April, is clinical director of High Weald PCN. While he acknowledges that most of his fellow clinical directors are drawn from the ranks of his younger colleagues, he also argues that old hands like himself bring some advantages to the role.
Roche’s experience and his time as the GP locality lead for High Weald means that he and his network colleagues already have the strong relationships with practices and GPs that will be crucial to their work.
Roche says: “We are really well advanced in terms of relationships with practices. I’ve been with the CCG for the last three years and as part of that I’ve been chairing monthly locality meetings. Given I’ve been working locally as a GP for 30 years I have got to know most of them anyway. They’ve all committed already to extended hours. It feels a very natural group.
“My background also means I obviously have contacts with the CCG and the local trust.”
Certainly, NHS England sees relationship-building as key to the success or otherwise of the networks. Its director of primary care, Dr Nikita Kanani, said earlier this year: “The key to successful primary care networks is the ability to work together as professionals, through trusting relationships, for the benefit of all our patients.”
However, it will also be interesting to see whether the leadership capacity at the very top of the new organisations will be adequate given the clinical director posts are funded for just two days a week.
Since retiring from his practice partnership in 2015 Roche has worked as a locum. He feels that the PCN role fits nicely into what has now become a portfolio career – hinting that the clinical director role could be something of a challenge for a GP partner to pick up.
“I feel fairly clear about the role but I was on the CCG board – we knew what was coming and there was a lot of talk about there about how PCNs are going to work.”
High Weald has also taken the decision to remedy what he describes as “a major omission” by deploying an experienced practice manager to handle the administrative side of the network. That work is being funded with some of the £1.50 per patient support the PCNs have received from NHS England.
Ironically, it might yet be the relationship with the CCG that initially at least proves rockiest.
“One difficulty could be that some CCGs have written into their business plans that networks will produce savings and that is cloud cuckoo land. We want to inspire general practice at a population level but they see us building relationships with the acute trust and the local authority and most clinical directors don’t have the experience or the time for that.”
Admitting that his own network has not yet contacted social care, Roche believes that the CCG’s expectations are fuelled by the funding PCNs have for the additional roles they are being encouraged to use to build wider primary care teams.
“Already to some degree the CCG is trying to push social care navigators on us. They have previously funded Age UK and others to provide a care navigator.
“We have a particular view that if we start attracting care navigators into general practice to talk about social care services then people will come to general practice for social care.
“We are more interested in providing first contact physiotherapists and clinical pharmacists in this first year. From next year we can choose what professions we would employ but the emphasis will be on assistant physicians and first contact physiotherapists from that pooled funding (for each network’s practices).”
He acknowledges, however, that a care navigator might be a sensible appointment in an expanded primary care team in more deprived areas.
While expecting very different looking primary care teams to emerge, Roche laments “the fantastic omission” of mental health workers from the list of professions the PCNs can employ with the DES funding.
And although Roche has meetings scheduled with the community and mental health trusts, he is not convinced they will transform their own ways of working in response to the arrival of PCNs.
“They are big organisations and I’m not sure they will tailor services to our small patch. The community trust says they will give us access to district nurses with a team manager based in a practice but that has been the case for the past few years so I’m not sure it is going to be a big new benefit.”
Roche has a cautiously upbeat approach to his new role and the likely impact on his practice colleagues and patients.
“The challenge is going to come next March and April when we see what we have to do to get the DES money. The service specifications are only set out in broad terms. They have promised that the GP contract will be amended each year and this has been the easier year, I suspect.”