Agenda item

 

This item is to receive an update in relation to the Primary Care Network landscape in the borough, how health services are delivered across these structures and to explore how these could be developed to better support Rotherham’s communities.

 

 

 

The Chair Welcomed Simon Langmead, Clinical Director of Rotherham Central North Primary Care Network, and Jude Archer, Assistant Director of Transformation at the South Yorkshire Integrated Care Board to the meeting and invited them to introduce the presentation relating to the role of PCNs in delivering healthcare services across the borough and their future contribution to neighbourhood-based models of care.

 

The Clinical Director of Rotherham Central North Primary Care Network outlined his role as a practising GP in Rotherham, Clinical Director of one of the borough’s six Primary Care Networks, Chair of the Clinical Directors Group and lead for neighbourhood health development across primary care. They explained that the presentation was intended to provide an overview of the development of the Primary Care Networks in Rotherham, their current structure, the work they were undertaking and their anticipated role within future neighbourhood health arrangements.

 

Members heard that Primary Care Networks had been established nationally in 2019 following publication of the NHS Long Term Plan and the associated five-year framework. Their creation had represented a significant change in the organisation of general practice by encouraging and requiring GP practices to collaborate more closely in delivering services for defined populations. Previously, GP practices had largely operated as individual businesses with limited joint responsibility for service delivery. The introduction of PCNs was therefore described as a major cultural and operational shift, supported by targeted funding intended to strengthen collaborative working and expand the scope of primary care provision.

 

The Commission was advised that Rotherham’s PCNs had evolved from the former Clinical Commissioning Group locality structures. Whilst the previous arrangements had primarily supported communication and peer support between practices, the formation of PCNs brought greater responsibility for joint working and service delivery. Six Primary Care Networks had subsequently been established across the borough, each serving populations ranging from approximately 35,000 to 55,000 residents. The networks had largely developed from pre-existing relationships between practices and therefore did not always align with clear geographic boundaries.

 

Detailed information was provided regarding the composition of each network. Health Village and Dearne PCN covered practices within central Rotherham and parts of the northern borough. Maltby and Wickersley PCN served practices based largely around the Maltby and Wickersley geography. Raven PCN consisted of a cluster of practices serving a broad central and southern area. Rother Valley South PCN represented the most geographically coherent network, covering communities including Dinnington, Thurcroft, Swallownest and surrounding areas. Central North PCN served central and western parts of the borough, including Kimberworth and Greasbrough. Wentworth 1 PCN covered a large area across the northern borough, Parkgate, Rawmarsh and parts of central Rotherham. Members were shown a map illustrating the extent of each network and were advised that significant overlap existed between many PCN boundaries, particularly within central parts of the borough.

 

The wider organisational structure of primary care within Rotherham was then explained. Members heard that the borough contained 28 GP practices, which collectively formed the six Primary Care Networks. Above this structure sat Connect Healthcare CiC, the borough-wide GP Federation, which comprised all practices and provided services at scale across Rotherham. This arrangement enabled services to be delivered collaboratively where a borough-wide approach was more effective than individual practice or network provision.

 

The Commission received a detailed explanation of the principal functions undertaken by Primary Care Networks through the Direct Enhanced Service (DES) contract. Members were informed that the DES framework was designed to support, connect and expand primary care provision, with nationally allocated funding used to deliver agreed priorities and service improvements.

 

Particular attention was given to the Additional Roles Reimbursement Scheme (ARRS), which represented the largest element of PCN funding. The Clinical Director of Rotherham Central North Primary Care Network explained that the scheme had been created during a period of significant workforce shortages in general practice and was intended to diversify the primary care workforce by funding a wide range of additional professional roles. These included pharmacists, physiotherapists, mental health practitioners, care coordinators, social prescribing link workers, physician associates and other specialist practitioners. More recently, funding criteria had been extended to include GPs and practice nurses. Networks were able to determine which roles would best meet the needs of their populations, enabling them to tailor workforce development according to local priorities. The scheme had increased capacity, broadened expertise within primary care and enhanced service provision for patients.

 

Members also heard about the Enhanced Health in Care Homes programme, an area in which Rotherham had been a national pioneer. Prior to the introduction of the scheme, residents in care homes often remained registered with multiple GP practices, resulting in fragmented healthcare arrangements and inefficiencies. Rotherham had proactively aligned individual care homes with specific GP practices before the national PCN arrangements were introduced. This model had subsequently been adopted nationally and incorporated into the PCN framework. As a result, every care home for older people in Rotherham was aligned with one or, in some cases, two GP practices. Regular ward rounds, vaccination programmes, care planning and proactive healthcare management were now delivered in a more coordinated manner, improving continuity of care and strengthening relationships between healthcare professionals, residents and care home staff.

 

The presentation also covered Enhanced Access arrangements, under which Primary Care Networks were required to provide appointments outside standard weekday opening hours. Members were advised that five of the six PCNs delivered these services collaboratively through Connect Healthcare CiC, allowing evening and weekend appointments to be provided efficiently through shared hubs. This joint approach enabled more appointments to be offered than the minimum national requirement. Rother Valley South PCN had instead developed its own local model to meet the needs of its communities.

 

Further information was provided regarding the Investment and Impact Fund, through which PCNs received funding linked to achievement of specific national priorities. Current priorities included increasing uptake of annual health checks for people with learning disabilities and improving colorectal cancer screening pathways through the use of faecal immunochemical testing (FIT). The Clinical Director of Rotherham Central North Primary Care Network explained that these initiatives helped support earlier diagnosis, better targeting of specialist services and improved patient outcomes.

 

Members were also reminded of the pivotal role Primary Care Networks had played during the COVID-19 pandemic. From December 2020 onwards, PCNs had been central to the organisation and delivery of the vaccination programme across Rotherham. The programme had required unprecedented collaboration between GP practices and had demonstrated the effectiveness of network-based working. The Clinical Director of Rotherham Central North Primary Care Network described the vaccination programme as a significant early test of the new PCN model, which ultimately strengthened relationships and collaborative working across the borough.

 

The Commission heard about a current programme of proactive care being developed through the networks. This work focused on prevention and earlier intervention for cohorts of patients at greater risk of poor health outcomes. One strand targeted younger adults aged 18–39 who experienced both mental health conditions and physical long-term health conditions, recognising that physical health needs were often overlooked within this group. Another strand focused on residents experiencing complex frailty, with the aim of identifying needs earlier, preventing deterioration, supporting independence and improving quality of life. The programme sought to reduce avoidable demand on acute services through more proactive community-based support.

 

Looking ahead, the Clinical Director of Rotherham Central North Primary Care Network explained how Primary Care Networks were expected to contribute to the developing neighbourhood health model previously considered by the Commission. They suggested that PCNs had already provided a blueprint for neighbourhood working by demonstrating how different professionals and organisations could collaborate around shared population needs. However, they acknowledged that the current PCN geography in Rotherham presented challenges due to overlapping boundaries and differing population distributions. As a result, significant work had been undertaken to reconsider local geography and align services more effectively with emerging neighbourhood arrangements.

 

Members were informed that Rotherham was involved in the National Neighbourhood Health Implementation Programme, providing an opportunity to test and shape new approaches to integrated local care. The Clinical Director of Rotherham Central North Primary Care Network outlined emerging national proposals for future health service contracting arrangements, including potential neighbourhood provider models and integrated health organisations. These developments were intended to bring services together around local communities, promote prevention, improve access to care closer to home and make greater use of technology.

 

The presentation concluded with an update on local neighbourhood development. The Rotherham Place Board had recently agreed to implement four shadow neighbourhood areas over a twelve-month period to test new collaborative arrangements. These emerging neighbourhoods would bring together multiple Primary Care Networks alongside community health teams, voluntary sector organisations and other partners. Initial priorities would focus on supporting residents with complex frailty through integrated neighbourhood teams, with the objective of improving quality of life, reducing avoidable hospital admissions and enabling more care to be delivered within community settings closer to people’s homes.

 

Councillor Garnett welcomed the presentation and asked how equitable access to services was being achieved across the borough given the overlap between Primary Care Networks and the varying geographical coverage shown within the report.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that each PCN had been designed to respond to the specific needs of its local population and had developed bespoke workforces and services accordingly. They noted that this was particularly evident within the Additional Roles Reimbursement Scheme, where individual networks had chosen different combinations of professionals to reflect local requirements. They further explained that this localised approach was balanced by the borough-wide role of Connect Healthcare CiC, through which all practices worked collaboratively to provide services available to the whole population. They advised that it was the combination of tailored local provision and borough-wide services that helped ensure equitable access for residents.

 

Councillor Garnett referred to the emerging neighbourhood health agenda and asked what shortcomings existed within the current PCN arrangements that neighbourhood reforms represented an opportunity to address, and what practical improvements residents would experience as a result.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that the original PCN structures had been established around existing relationships between GP practices rather than around communities or geography. Whilst this had helped create effective working relationships during the early stages of implementation, it had also resulted in significant geographical overlap and inefficiencies. They advised that as Rotherham’s population had become older, frailer and more complex, there had been increasing recognition that services needed to be organised around neighbourhoods and communities rather than historic organisational structures. They stated that neighbourhood working would allow professionals to better understand local communities, reduce duplication, improve coordination and enable care to be delivered closer to where people lived. They noted that the proposed reforms sought to retain the collaborative strengths of PCNs whilst addressing geographical inefficiencies and improving outcomes for residents.

 

Councillor Fisher asked how the six Primary Care Networks identified and prioritised local health inequalities and whether any data or evidence existed regarding variations in health outcomes between populations served by different PCNs.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that a growing range of data sources was available to PCNs, supplemented by increasing collaboration with public health colleagues. They advised that, historically, much of the decision-making had been driven by the knowledge and experience of local GPs who understood the needs of their registered populations. However, more sophisticated datasets were now available, including prevalence data, screening uptake information and broader population health intelligence. They noted that inequalities manifested themselves in different ways across different communities and that PCNs increasingly used such information to guide workforce planning and service investment, particularly where disparities were identified in areas such as cancer screening and preventative health activity.

 

Councillor Fisher wanted to understand whether evidence existed that the Additional Roles Reimbursement Scheme had successfully expanded primary care capacity and how the performance of these additional roles was measured.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that the introduction of new professional roles had originally been intended to increase capacity at a time when additional GP recruitment had proved difficult nationally. They acknowledged that both patients and practices had required time to adapt to a more diverse workforce, as many residents had traditionally expected all healthcare needs to be addressed by a GP. They advised that staff funded through the scheme were now closely monitored through appointment activity data and performance reporting. They further stated that whilst the scheme had clearly increased appointment capacity, it had also enhanced the quality of services available. Examples included clinical pharmacists undertaking specialist medication reviews, social prescribing link workers addressing wider social needs and dedicated dementia support roles. Although some of these benefits were not easily quantifiable through performance metrics alone, they reported that they were widely recognised by both patients and healthcare professionals.

 

Councillor Thorp raised concerns about the geographical configuration of the networks, questioning how arrangements could operate efficiently when practices in distant and seemingly unrelated communities were grouped together.

 

The Clinical Director of Rotherham Central North Primary Care Network acknowledged the limitations of the current geography and explained that, when PCNs were established, the priority had been to build on existing working relationships between practices rather than strict geographical alignment. They reiterated that requiring independent GP practices to collaborate represented a significant cultural change and that grouping practices with existing relationships had been a pragmatic approach. They added that the current neighbourhood health reforms were partly intended to address these geographical challenges by creating structures that reflected communities more accurately.

 

Councillor Thorp asked what practical benefits patients experienced as a result of GP practices being organised into Primary Care Networks and sought confirmation that all practices within the borough were members of a PCN.

 

The Clinical Director of Rotherham Central North Primary Care Network confirmed that all 28 GP practices in Rotherham belonged to one of the six networks. They explained that the greatest benefits had come through workforce expansion and service diversification. Patients were now routinely able to access professionals such as physiotherapists, pharmacists and social prescribing workers through their own GP practices, often without realising those services were funded through the PCN structure. This had increased appointment availability, improved access to specialist expertise and strengthened links between primary care and wider community support. The ICB Portfolio Director, Contracting & Commissioning and Place Relationship Lead for Rotherham added that PCNs also enabled practices to learn from one another and share examples of best practice, leading to continuous improvement across the borough.

 

Councillor Harrison observed that the presentation focused primarily on structures and programmes rather than outcomes and asked what performance indicators were used to assess the effectiveness of PCNs and how residents were informed in respect of PCN performance.

 

The Clinical Director of Rotherham Central North Primary Care Network acknowledged the point made and advised that PCNs were subject to several forms of performance monitoring. The Investment and Impact Fund formed the principal national performance framework and included measures such as annual health checks for people with learning disabilities and the use of faecal immunochemical testing within colorectal cancer screening pathways. In addition, appointment activity across the various Additional Roles Reimbursement Scheme workforces was closely monitored and reported to commissioners. They explained that wider practice and network performance data was regularly reviewed. In relation to public awareness, they noted that efforts had initially been made to explain the purpose of PCNs to residents, but over time the additional services had become embedded within everyday general practice, resulting in many patients being unaware that the services they were receiving originated from the PCN model. They suggested that this integration itself reflected the success of the approach.

 

Councillor Harper asked whether the enhanced access services delivered by PCNs had reduced pressure on accident and emergency departments and what further work was planned if such benefits had not yet materialised.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that the use of shared evening and weekend hubs allowed primary care to deploy resources more efficiently than if every practice attempted to open independently outside normal hours. They stated that the shared model freed resources for clinical activity and enabled more appointments to be offered than national requirements stipulated. Whilst there was a reasonable expectation that these services should help reduce pressure on urgent and emergency care, he acknowledged that attendance at accident and emergency departments continued to increase nationally and locally. They highlighted examples of collaborative initiatives with Rotherham Hospital, including acute respiratory infection hubs, where patients presenting at hospital could be redirected into primary care services where appropriate. They advised that ongoing discussions were taking place between primary care, The Rotherham NHS Foundation Trust (TRFT) and wider partners regarding how urgent demand could be better managed across the whole system.

 

Councillor Yasseen reflected that the subject matter had been difficult to scrutinise due to the highly structured national policy framework underpinning Primary Care Networks. Referring to documentation produced when PCNs were first established in 2019, she questioned whether earlier aspirations to align PCN boundaries with the Council’s neighbourhood model had ever been implemented and whether they could now be revisited given the ongoing evolution of neighbourhood healthcare arrangements.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that they were not involved at the time the original decisions had been made but acknowledged that the current geography created challenges and inefficiencies. They stated that the emerging neighbourhood model sought to address many of those concerns by aligning healthcare delivery more closely with recognisable communities and ward-based geographies. The ICB Portfolio Director, Contracting & Commissioning and Place Relationship Lead for Rotherham added that the four neighbourhood model currently under development represented a twelve-month exploratory phase rather than a final destination. They stated that the intention was to test new approaches, strengthen collaboration between organisations and identify opportunities for improved alignment in future years.

 

Councillor Yasseen sought clarification on whether the existing central area arrangements, involving multiple overlapping PCNs, would eventually change under neighbourhood working arrangements.

 

The Clinical Director of Rotherham Central North Primary Care Network explained that the transition was complex because PCNs were not standalone organisations but collaborations of independent GP practices, each with its own staffing arrangements, premises and regulatory responsibilities. They advised that neighbourhood development was therefore focused initially on aligning organisations around common geographies whilst maintaining existing structures during the transition period. All partners, including primary care, community health services, social care, local government and the voluntary sector, had agreed to work within the four new neighbourhood footprints for twelve months, after which progress would be reviewed and future developments considered.

 

The  Managing Director, TRFT supplemented the discussion by acknowledging the complexities involved in coordinating independently operated GP practices. They praised the significant achievements already made through the Primary Care Network model and explained that neighbourhood working represented the next stage of development. They informed Members that partners across primary care, community health services, mental health services, social care, voluntary organisations and the Council’s neighbourhood teams were now working collectively to establish common neighbourhood arrangements. They stressed that the current model should be viewed as a starting point rather than a final solution and that the primary objective was to demonstrate that greater collaboration could deliver improved outcomes for residents before any longer-term structural changes were considered.

 

The discussion concluded with Members noting both the progress achieved through the Primary Care Network model and the opportunities presented by neighbourhood health approaches to improve integration, reduce inefficiencies and strengthen community based healthcare delivery across Rotherham.

 

Resolved:-

 

That the Health Select Commission:

 

1. Noted the contents of the presentation received.

 

2. Be furnished with data which quantifies the performance of each respective PCN serving the Rotherham borough.

 

3. Receive updates, via an appropriate method and at appropriate intervals to be determined, in relation to how the Primary Care Network in Rotherham continues to develop to support the National Neighbourhood Health Implementation Programme.