Report of Medical Director, Manchester Health and Care Commissioning and Chief Medical Officer, Manchester Local Care Organisation is attached.

The Board considered a report from the Medical Director, Manchester Health and Care Commissioning and Chief Medical Officer, Manchester Local Care Organisation and a presentation which was introduced by the Medical Director (MHCC), Dr Manisha Kumar and the Chief Medical Officer (MLCO), Dr Sohail Munshi, who informed the Board of the introduction of Primary Care Networks (PCNs), and outlined progress on their establishment in Manchester, as well as wider implications for the City.

In particular, the report focused on how PCNs would fit into the development of integrated place-based care in neighbourhoods, and the Manchester Local Care Organisation (MLCO).  It was reported that Manchester’s focus in terms of the integration of health and social care at a local place-based level had been through the neighbourhood arrangements.  In the context of Bringing Services Together, MLCO was working with a range of partners in neighbourhoods to enhance the approach to integrating health and social care and addressing the wider determinants of health.  In this context, it was recognised that PCNs and neighbourhoods were not identical, but had very similar aims and in most cases, similar geographies.

It was noted that PCN’s had been established with challenging timescales.  The national guidance had only come out in January 2019, but they had been assisted locally by the fact that Manchester had a number of the building blocks in place to ensure the relatively smooth and effective implementation. Whilst there was general agreement in Manchester that the 12 Neighbourhoods should act where possible as the basis of Manchester’s PCNs, it should be noted that the guidance reinforced the view that PCNs should develop ‘bottom up’ from the Practices themselves. It was also explained that broadly, neighbourhoods were focusing on the integration of health and social care, whilst PCNs were focusing on Primary Care service delivery, and how they deliver their requirements under the PCN Directed Enhanced Service (DES).It was explained that there were and would be growing links between PCNs and neighbourhoods, and the ambition was to align where possible. It was also recognised that not all PCNs would move forward at the same pace, and some may wish to approach delivery of their PCN DES requirements in different ways.

The Chair invited questions from Board Members.

A Board Member queried how would MHCC overcome the challenge of the different contractual obligations of the PCN and the priorities of the neighbourhood marrying together whilst achieving the asks of the neighbourhood.

Dr Kumar advised that as the guidance and proposed framework was national and not tailored towards Manchester, there was some scope within the system whereby if Manchester was fulfilling the vision of Networks integrated into communities and place based care, the delivery of this would be, to some degree, down to Manchester.  It was also reported that with strong supporting leadership to the 14 Networks, it was hoped that there would be appropriate system support available. Dr Munshi advised that it was envisaged that by ensuring that the Clinical Director and Neighbourhood Lead worked together with Population Health colleagues, this would ensure plans were co-produced.

A Board Member acknowledged the hard work that had been undertaken and its pace of progress in establishing 14 PCN’s across the city, which covered 88 practices.  The Board Member also emphasised the power of having Primary Care in the position it was in in terms of longevity with patients and the ability to offer care in relation to the impact of social inequality and having a trauma informed approach.  The Board Member asked if there were any bespoke examples of how a PCN was working at a neighbourhood level.

Dr Munshi provided an example of how his own neighbourhood Network had responded to developing an greater understanding  of population health and JSNA data and the resulting work that had been developed.

The Executive Director of Adult Services welcomed the development of additional roles other that just GP’s that patients would have access to but added that it would be important to fully consult with patients on these proposals to ensure that they were supportive of the direction of travel

A Board Member asked whether the national guidance for establishing PCN’s was the way MHCC would have wanted to deliver these and commented on the need to acknowledge the need to ensure the flow through of investment to the voluntary sector as both the social prescribing model and commissioning of services from the voluntary and community sector grew, pushing demand onto the sector as a way of reducing need.

Dr Kumar advised that in terms of Manchester the guidance built on what was already being done but put it within a contractual framework.  She reported that years 2 to 5 were not yet set in any detail so there was an opportunity to influence the contract through joint working between Clinical and Primary Care leadership.  Dr Kumar advised that there had been heavy investment into pharmacy and social prescribing over the last five years.  In order to support the offer, MHCC had tried to build on what already existed and give sustainability for funding over and above in year return on investment.  The Chair added that there had been many discussions around the understanding of what social prescribing actually meant and that this was something that still needed development and how it linked into the Our Manchester voluntary and community sector grant funding.

A Board Member enquired about access to counselling services. Dr Munshi advised that all PCN’s had identified the need to access suitable mental health services.

A Board Member asked how MHCC intended to capture and measure additional success above the contract requirements.  Dr Kumar advised that this would depend on the capacity of the PCN’s to embrace the momentum of change.  There was also the opportunity to do many things differently in conjunction with the LCO as there had to be out of hospital based care, this included the delivery of standards in a collaborative neighbourhood based approach, primary care access and urgent primary care non-core access and nursing home care.

Decision

The Board thanks the work or Dr Kumar , Dr Munshi and other GP’s to date in establishing the 14 Primary Care Networks.