Context: huge demands, rapid change and varying leadership experience
The expectations of PCNs and clinical directors were challenging even before the pandemic, and the response to Covid-19 has demonstrated just how important their role can be. The rapidly changing landscape means we have needed to be flexible in working with changing development needs. Increasing clinical demand and workforce shortages also mean that protecting time for learning and development is difficult for many in the health system, but people we’ve been working with during the pandemic have told us how important it can be in supporting their response.
While some PCNs have formed from groups of practices that have been working together for a long time, many are brand new relationships, or are dealing with the legacy of past conflicts that need to be resolved. PCNs have also had to build new relationships with other parts of the health and care system. We’ve found that building relationships, improving dialogue and conflict management are consistent themes in our work.
PCN clinical directors are very diverse in their leadership experience, with some having huge experience in clinical commissioning group (CCG) governing bodies or GP federations, but many others are taking on their first cross-organisational leadership roles. Many of the PCN clinical directors we have worked with haven’t had much access to leadership development and are used to more didactic forms of learning, with much less experience of peer-to-peer or self-directed learning that starts with the problems they are encountering in their everyday working lives.
Our approach: creating learning communities
We have now worked with different groups of PCN clinical directors and wider PCN teams across England. While we’ve worked flexibly with them to adapt our approach to meet their particular needs, a core principle is that we create a learning community where members get to know and trust each other. We have found that working with a consistent group of people makes it possible do the deeper work that builds collective confidence, authority and resilience.
We know that this approach can be challenging when leaders have many competing demands on their time. However, without consistency and time, it can be difficult to build enough trust to get beyond surface issues. This seems important given the complex and ambiguous task that PCN leaders have before them.
We use these learning communities as our underlying approach, and have developed a range of different offers, including:
- working with regional groups of PCN clinical directors to co-design a flexible programme to address issues that are important to the group rather than delivering a pre-determined programme. Not surprisingly there are common requests which include leadership, collaboration, dealing with conflict, innovation, teamwork, strategy, engagement
- supporting individual PCNs, working with leadership teams to develop their shared purpose, vision, direction and process
- convening project-, place- or individual-based action learning sets. This involves a smaller group of up to eight people working on individual issues or a joint project for their PCN or for the PCN with wider partners. You can read about how we used this approach in our work in Kent, Surrey and Sussex
- supporting individual clinical directors through coaching to support specific leadership development goals or to build their own coaching and facilitation skills.
The feedback from the PCNs we’ve worked with reflects our wider experience of developing leaders: first, that they find the opportunity to be introduced to theory and apply it to everyday challenges with peers to be invaluable – often, we hear leaders talking about feelings of isolation, or that they feel that they should have all the answers or be able to simply apply models of care or improvements when their realities are messier and more complex. We see participants engaging with these realities by sharing their challenges with their peers which helps to build confidence and a healthier perspective on some of the challenges they are facing. And second, that fostering trusting relationships and a collective sense of direction builds energy and a positive sense of possibility that sustains beyond the programme – people feel able to go further together than they do alone.
Planning PCN development? Some questions to consider
For those thinking about providing or commissioning development support for PCNs and PCN clinical directors, we think the following questions are critical.
- What have you learned so far about PCN development? What’s gone well and what remains to be attended to?
- Do you know which development needs are emerging as the most important for 2021 and beyond?
- Are there significant differences in needs in the different PCNs and what offer might meet joint and different needs?
- How are you helping to create the conditions for a productive learning community? How might you start to create these conditions if they don’t already exist?
It is increasingly difficult for an individual to make their views known without fear of targeting as many staff have been forced to join PCNs despite clear reservations and obvious deficiencies of these organisations . These PCNs are in effect without choice, yet we can see serial meeting attenders and committee hoppers join the ranks of the Clinical Directors in many cases those same individuals who have already led primary care into the abyss. They sit on all the other committees such as LMCs, GP boards and do little token frontline work.
We are being forced to take on staff we don't need and now we have entire half days completely empty of appointments or being filled with patients just to show that the PCN roles are required when in many cases clearly they are not.
For a proportion of practices , PCNs will work and these will be used to push the agenda, but hundreds of millions will be wasted in the interim as we are being forced to engage in a process which is simply not needed but being supported by individuals taking up highly paid Clinical Director roles with a day off per week at a cost of £2500 monthly each to the NHS which helps no one but those who want further meetings, leadership titles and less frontline work.