Navigating the Challenges of Disbanding a Primary Care Network (PCN) Key Drivers, Processes, and Lessons Learned

The decision to disband a Primary Care Network (PCN) is not to be taken lightly. It often results in a long, slow, and painful breakup involving a multitude of considerations, from relationships between clinical directors to the logistical and financial complexities of reallocating resources and staff.

In this blog, we explore some of the key considerations networks will have to work through when separating;

🎯 Financial and logistical considerations

🎯 HR, employment law and staff allocation

🎯 Communication and relationship management

🎯 Maintaining business as usual

This blog also;

🎯 Summarises the key drivers for networks separating and advice for new networks post-divorce

🎯 Provides 12 key questions to consider when forming your new vision and ways of working

A big thank you goes to Sandra Anderson, Head of Business Development & Transformation at Barnet Primary Care Network 3, for sharing some of her experiences with me and Dr Nufar Wetterhahn, Clinical Director for allowing me to share these insights.

DISCLAIMER: This blog is for those networks weighing up the pros and cons of staying together or splitting up.

If you are part of a happy and productive network, this blog is not for you 😀.

This is an in-depth guide, so remove distractions and grab a notebook.

Let’s jump in!

Key Drivers for Disbanding the PCN

The primary drivers of the PCN's breakup typically fall into five key themes, which are all intertwined.

1️⃣ Trust

2️⃣ Equity

3️⃣ Size

3️⃣ Geography

4️⃣ Differing visions

This may look like:

➡️ Co-clinical directors with differing visions relating to the PCN.

➡️ Practices opposed to the leadership provided by the clinical director.

➡️ A lack of trust typically relating to the distribution of resources.

➡️ Assembling a large network, for example, ten-plus practices, seemed like a good idea in the beginning, but it no longer seems viable or efficient.

➡️ Equity and facilitating processes and forums to enable everyone to have their voice heard becomes increasingly difficult.

➡️ The geography of some PCNs spans too wide with central services, leaving certain practices disadvantaged or hard to recruit to.

➡️ Lack of engagement with some practices reaping the same rewards as the highly engaged and high-performing practices.

If you find yourselves in this situation, here are some things you may wish to consider:

🎯 Financial and Logistical Considerations:

When contemplating the breakup, financial viability is a major concern.

Work closely with your accountants to forecast the optimal size for a sustainable PCN.

This involves evaluating which practices were geographically and operationally aligned and how to ensure fair engagement and accountability.

You may also have to unpick the financial history if things aren't clear. be warned. This will be time-consuming.

🎯 HR, Employment Law and Staff Allocation:

The process of reallocating staff between the new networks can be particularly complex. So, it’s essential to seek HR expertise to ensure the rules relating to the Transfer of Undertakings Protection of Employment rights (TUPE) are followed to manage these transitions fairly.

I sought the advice of Sandra Anderson, the Head of Business Development & Transformation at Barnet Primary Care Network 3, who has gone through this process. She emphasised the importance of engaging with internal and external HR advisory services to ensure compliance with employment laws and to maintain fair treatment for all staff members. This involved detailed conversations around roles rather than personalities, ensuring a needs-based approach to staff allocation.

🎯 Communication and Relationship Management:

Maintaining transparent and effective communication with all stakeholders is essential.

Remember, poor communication and relationship management likely lead you to the situation you are in now.

Continuous engagement with clinical directors from the new PCNs will be necessary to negotiate which practices will join and what the resource sharing will look like. It will also be required to ensure that everyone is aware of their options and the rationale behind decisions.

The importance of organisational development support

Some practices will have made alliances to stay together, and one or two practices may not be wanted by the newly forming networks, so start as you mean to go on and do some organisational development.

You may find working through the list of questions below helpful.

1️⃣ Define your vision and values.

2️⃣ How can you collectively best serve your population?

3️⃣ Clearly articulate expectations for practices.

4️⃣ Outline your decision-making principles.

5️⃣ How will you manage conflict?

6️⃣ How will you allocate resources?

7️⃣ What makes sense geographically and operationally?

8️⃣ What does trust look like to us?

9️⃣ How often will we meet, and what will our meeting etiquette be? ( Online only, cameras off, people arriving late and no engagement? A lot of networks operate like this).

1️⃣0️⃣ What are your strengths?

1️⃣1️⃣ What are your weaknesses?

1️⃣2️⃣ Where are the opportunities to build something stronger than before?

ETC….

Be honest and upfront, and only enter into another partnership with all the cards on the table.

Now, I know this is easier said than done, as there will be pressure from a variety of sources to say yes when you want to say no.

This is where strong leadership comes into play. Think of the vision and learn from the past.

Further considerations to work through

When it comes to planning, staff integration, and organisational development, here is a starter for ten provided by Sandra.  

Administrative Support:

• Assistance with paperwork and documentation related to joining the PCN.

• Support in navigating any changes to policies or procedures.

• Access to administrative staff or resources within the PCN for assistance with scheduling, billing, and other administrative tasks.

  
  

Clinical Support:

• Integration into existing clinical workflows within the PCN.

• Any collaboration with other healthcare professionals within the network.

• Support in adopting and implementing any new clinical guidelines or protocols.

Staff Training and Organisational Development:

• Ongoing training and professional development opportunities to stay updated on current medical practices and policies.

• Facilitated meetings with quantified requirements, e.g. x number of facilitated sessions with funded backfill for all the GPs attending. 

IT Support:

• Assistance with any integration/data sharing with the PCN's systems.

• Support for any technical issues related to communication tools or platforms used within the network.

• Additional hardware (e.g. laptops) required.

Financial Support:

• Information on reimbursement processes and financial arrangements within the PCN.

• Assistance in understanding and navigating any changes to billing or payment systems.

Networking Opportunities:

• Introduction to other healthcare professionals within the PCN.

• Opportunities for collaboration and networking events to foster professional relationships.

  
  

Patient Engagement Support:

• Guidance on engaging with patients within the PCN, including any specific initiatives or programs – collaborative PPGs?

• Access to resources for patient education and communication.

  
  

Quality Improvement Support:

• Participation in quality improvement initiatives within the PCN.

• Access to data and resources for monitoring and improving clinical outcomes.

Legal and Regulatory Compliance:

• Cost to have Network Agreement reviewed/amended. You may need legal expertise or advice from your LMC for this.

Mental Health and Well-being Support:

• Access to resources or programs that support the mental health and well-being of healthcare professionals.

• Awareness of any counselling or support services available within the PCN. 

Lessons Learned and Moving Forward

Reflecting on her experience, Sandra Anderson shared several key lessons:

1️⃣ The role of the clinical director (CD) and manager: The CD's leadership is critical in providing vision, stability, and clear clinical direction, ensuring that the PCN and its senior leadership team remain aligned throughout the process.

It is an extremely tough process that will require significant focus and will take a heavy toll on both the CD and the manager. It will really require a supportive team around the CD and manager who are leading the PCN to ensure that they have the strength and bandwidth to do this.

In relation to the PCN Manager, which is often a far-encompassing title, it is important that those who hold the role feel professionally able to navigate this situation and are sufficiently supported by their Clinical Director. If support is needed, it should be invested in or outside support brought in, as further highlighted in the point below.

2️⃣ The importance of support: Having sufficient management, HR, and legal support is critical. Sandra noted that more management support would have been beneficial to handle the workload and stress associated with such a significant transition.

3️⃣ Maintaining business as usual: In addition to managing this huge process, the senior leadership team (CD & manager) must ensure that the PCN continues running operationally.

They will need to ensure that all current workstreams and targets continue to operate effectively and that the workforce does not become destabilised.

All too often, the scale of the challenge is not adequately understood, so some networks, when faced with a potential structural strategic change will want to rush things. Take it slow and carefully think through this process.

4️⃣ Building a collaborative environment: Continuous development efforts, like organisational development (OD) work and regular check-ins, were crucial in keeping all practices aligned and engaged.

5️⃣ Compassionate leadership: Sandra highlighted the importance of compassionate leadership and clear communication in building a PCN where staff feel valued and respected. This involves understanding the organisation's staff needs and ensuring those needs are met.

Final thoughts

Disbanding a PCN is a complex, multi-faceted process that requires careful planning, clear communication, and a fair approach to managing financial and human resources.

Remain professional, and don't waste your valuable energy gossiping, confirming the decision to split, or looking for evidence of foul play. ( Tara's words and not Sandras's). Whatever has happened has happened. Now it time to look forward.

I hope this blog helps.

Key contact details

1️⃣ If you would like to contact Sandra, she can be found here.

2️⃣ If you would like some organisational development support, contact us here.

3️⃣ If you have advice, lessons learnt and best practice to share and would like to be featured in the blog in the future, contact us here.

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About the Author

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.  

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

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