GP networks need new leadership, says NHS England lead

Acting medical director for primary care Nikki Kanani told HSJ different types of people were taking an interest in becoming the clinical director for their network.

Identifying a clinical director is one of the early requirements of forming a PCN. All GP practices are expected to join a PCN under the new national GP contract which begins in April.

Dr Kanani said she hoped the roles “will bring in new leadership”. She said she was “respecting [of] previous leadership, but we need a new style of leadership, we need to make sure it’s collaborative and connected, and representative”.

She said the idea of moving senior clinicians in CCGs to be PCN leaders “doesn’t feel quite right to me”.

She said: “In some areas that might be the right person, but I think that needs to be a conversation between practices as to what is the right type of representation because it is a provider role not a commissioner role.”

Dr Kanani is a GP in Bexley and has previously led Bexley CCG. She took up the NHS England role in the summer, having previously been deputy primary care director for NHS England part-time.

Dr Kanani said PCN clinical director roles were already in some areas attracting GPs who had not engaged with system leadership before. At least one area – Nottingham – was developing “some sort of election process so that we can make sure we get new leadership into the system”, she told HSJ.

She confirmed the roles were not only for GPs: “It’s ‘clinical’ not ‘GP’ director, so, in some areas, we know that other clinicians will step into that role.”

Dr Kanani said there had been calls for more guidance on PCNs, including the director role, with GPs anxious to find out what NHS England intends, and that some would be published soon.

However, she is loath to provide too much. “I don’t want to suffocate the system by providing too much guidance because then everyone will have to follow guidance and networks are more a philosophical way of working,” she explained.

She said some previously established PCNs were in the process of changing shape and size, sometimes to better match community health providers’ plans.

Early days

She stressed that there was not a requirement for unrealistic progress with PCNs where relationships were not strong.

Areas “where there are challenges” are subject to the national expectation to propose a network footprint by May, “but then from July [when PCNs go live] we’re not going to be asking you to do much more”.

“We’re going to then ask you to be building on those relationships, because relationships are at the core of this, but this is why it’s a five-year plan because it’s going to take longer than now to May, [or] May to July, for us to deliver what we want to where we want to get to,” she said.

The development of PCNs is part of a five-year GP contract deal between NHS England and the British Medical Association, which also aims to create about 20,000 new non-GP posts in primary care, mostly under a new “network contract” arrangement.

She said few networks had so far taken the option of asking community trusts to employ their network staff, and most were planning to use vehicles like GP federations or alliances and large-scale GP providers.