Digital PCN HUB Innovation

Summary

Deeper and wider collaboration between practices is key to achieving at scale services for patient populations. By working together at greater scale, general practice can be both ‘small’ and ‘big’. It can keep providing patients with personalised, whole-person care at practice and network levels. PCNs hubs can provide strategic support and leadership to their practice organisations and with the right support and focus, this can lead to better population-based, person-centred, primary care, as well as more powerful participation in the wider care system as is the way forward with the Integrated Neighbourhood model Approach.

Collaboration is not new to general practice and considerable progress has been made towards the vision with practices and PCNS developing stronger relationships with each other and with other care providers. This takes effort, time and courage considering the challenges we face as a system that include growing demand for GP practice services due to population growth, older patients with more complex needs, increased patient population with long-term conditions, a struggling workforce, low morale and more.

PCN Hubs working at scale can tackle the challenges facing practices by helping them to develop more robust cross-organisational working, offers the ability to combine different services for people who are at risk of developing acute illnesses or going into hospital which in turn supports them to manage the health of whole populations offering more care by redesigning community based and home based services in partnership with social care, and the voluntary and community sectors.

It allows for practices, PCNs and other healthcare providers to take collective responsibility for health outcomes, and for how well they perform financially and operationally.

The South East Region is leading the way with work that has been undertaken to ensure that EMIS PCN Hub model clinical system is fit for purpose for PCN and practice staff to be able to deliver people centred care to a population and has delivered a pilot with Kent and Medway ICB, Folkestone Hythe and Rural PCN and it seven member practices that now offers to its staff:

  • ability to have a single sign on process and the ability to consult from one clinical system to reduce the number of accounts that PCN staff had to use
  • capability for cross-organisational tasking and shared access to service Appointment books hosted centrally
  • developing more efficient referral pathways and opportunities for better caseload management
  • a data strategy to support understanding of PCN service utilisation, meet contractual reporting needs and enable population health management

This regional pilot has successfully managed to deliver once for all solutions within the clinical system such as fit notes, and increased Appointment capacity through a federated delivery of services using sustainable funding streams adding over 4,500 Appointments per month to its seven practices. This innovative scheme and technical solution enables PCN staff to access patient records via a single log-on, as well as financial data, workforce structure, clinical and data governance arrangements.

Benefits to the PCN Hub model has shown:

Building capacity –Since November 2022, the PCN Hub has delivered 70,500 online consultations processed to date (4500 per month), 17,500 PCN minor illness appointments to date (1000 per month), 41,500 total PCN service appointments (3200 per month) and 11 healthcare services now delivered through the Hub.

Freeing up resources – initial feedback shows that the efficiencies generated by operating at scale have released both administrative and clinical resources at practice level, which can then be reinvested in supporting patients with more complex needs. An independent evaluation is currently underway to understand the full impact.

Supporting delivery – a total of 11 different services now operate out of the hub, helping the PCN to deliver against a range of service requirements set out in the 2024/25 GP Contract. It also allows the PCN to rapidly stand-up additional capacity as needed (e.g. winter access Appointments, CAS, acute respiratory infection, etc).

Enhancing business intelligence – the technical solution provides extensive management information including demand/capacity modelling, utilisation tools, monitoring of eHub activity and the automated tracking of new requirement for Access funding, GP contractual requirements, QOF and IIF data.

The NHS England South East Primary Care Transformation Programme has published a blueprint document and other learning resources

The innovative scheme and technical solution enables PCN staff to access patient records via a single log-on, as well as financial data, workforce structure, clinical and data governance arrangements.

Benefits to practices:

  • offering a single sign on process and the ability to consult from one clinical system to reduce the number of accounts that PCN staff had to use
  • providing capability for cross-organisational tasking and shared access to service Appointment books hosted centrally
  • developing more efficient referral pathways and opportunities for better caseload management
  • building a data strategy to support understanding of PCN service utilisation, meet contractual reporting needs and enable population health management
  • strong general practice voice in the provider landscape
  • strengthened practice resilience
  • effective system partnerships
  • on-going quality improvement
  • economies of scale
  • workforce development
  • new population based Approaches to care

Benefits to patients:

  • more consistent and accessible care, delivered by a multi-disciplinary team with the combined skills to meets their specific needs
  • care that is designed and delivered to suit their needs, provided by the right clinician, and accessed through a range of easy-to-use methods
  • speedy access to urgent medical advice
  • service from a health care professional who are motivated, happy, effective and focused on delivering care rather than drowning in administration
  • great care for life, from a joined-up, sustainable, high-quality, local networks with deep links to communities and a perspective that takes into account the whole population

Other innovative Approaches to care provision have taken place across the region adopting new technology and you can find out more in the Developing an understanding of local population section of this website.

Resources

Other innovative approaches to care provision have taken place across the region adopting new technology and you can find more on how these areas have delivered population health centric approaches such as:  

  • Pulmonary Rehabilitation Hub: Isle of Sheppey  
  • Remote Monitoring (for Proactive management of Diabetes Type II)