Understanding and mapping NHS Networks - the solution to PCO access problems?
(Published April 05)

Primary Care Groups have been in existence since 1999 and have gradually evolved into the Primary Care Trusts (PCT) that we know today. During this time, influence in terms of budget and decision-making has been slowly devolved from the old Health Authorities so that PCTs now have to commission, plan and develop services in conjunction with their local acute and mental health trusts. In addition, as part of a general move towards getting more treatment moved from the acute sector into the primary sector, more PCOs are providing their own services in a number of areas.

The aim of these changes is to allow services to develop in a more locally responsive way according the needs of the population, as well as taking into account historical ways of delivering services. For instance, there may be lots of community hospitals in some parts of the country, or a history of consultants running outpatient clinics in primary care in other parts.

However, one of the main challenges with operating under this system is that PCOs need to have the expertise within their organisations to make these strategic decisions. With many more PCOs than there were old Health Authorities (where the commissioning and strategic planning personnel were previously employed) the appropriate strategic expertise is obviously spread thinly.

Collaborative approach

One of the ways to mitigate the relative shortage of strategic input is for PCOs to work collaboratively with neighbouring PCOs and other NHS organisations as part of a network where learning, strategic development etc. can all be shared between the various elements of the NHS. Such networks should not be viewed as statutory organisations, but rather, they are networks that rely on local statutory NHS bodies for support. Networks are at different stages of development around the country: in some areas, effective networks are starting to exert a powerful influence on local services. The DoH sees a key role for these organisations in an NHS where resources, responsibility and decision-making are increasingly devolved to the frontline. This means that networks can provide a powerful forum for strategic planning and have real influence on commissioning.

Increasing numbers of networks

Networks have been set up to cover many disease areas as well as different functions within a PCT. Many networks have been established for a number of years:

• Thirty Four Cancer Networks were established over the period between 2000 and 2003 following the Cancer Report in 2000 where cancer networks were identified as the model for cancer services to implement the Cancer Plan. The networks include PCOs and Acute Trusts working together;
• Coronary Heart collaboratives were first established October 2000 and this has led to this approach being expanded so that CHD networks now cover all of England

Other networks include Mental Health Networks, Substance Misuse Networks and many other smaller, more informal groups based around the local provider trusts - as in the case of diabetes and other disease areas.

Non-disease networks include commissioning networks working to improve the efficiency and influence that the PCTs have on their provider trusts. They can also include public health networks, research and development networks, medicines management networks, specialist services commissioning networks and many others.

In Wales, Scotland and Northern Ireland the idea of working together is much more established, partly as a reflection of the reduced population and smaller number of acute trusts available.

Commissioning Care Networks

As far as Commissioning Networks are concerned, such networks typically vary in how they are set up or how strongly bound are the PCOs within them. This often depends on whether a single acute trust is the major provider for a number of PCTs, in which case it would make more sense for the PCOs to work closely together to commission services. For example, Newcastle PCT is leading on a 'commissioning consortium' that is pooling its resources with North Tyneside PCT and Northumberland Care Trust.

In other areas, where there are a greater number of provider trusts, some PCTs have grouped together to help with the commissioning, training and audit of services for a range of disease areas, with each PCT taking a lead role for different diseases.

PCTs in the East Hertfordshire Quadrant commission together. PCTs covered are: North Herts Stevenage PCT; Royston, Buntingford, Bishops Stortford PCT; South East Herts PCT and Welwyn and Hatfield PCT. Each PCT is taking on a lead development role on behalf of the quadrant, including training and audit.

This can usefully be compared with the situation in Devon, for instance, where one PCT leads on the commissioning of services on behalf of other neighbouring PCTs.

How can you tell which PCO will be part of a particular network?

It differs around the country. Below, we give an example of two different PCTs in the country and look briefly at a few of the networks that they are involved in:

Great Yarmouth PCT

Research and Development Network

Great Yarmouth PCT is part of Suffolk and Norfolk Primary Care Research Network (SuNet) which includes all the PCTs in Norfolk and Suffolk. Norwich PCT has taken on the role of lead PCT for hosting the arrangements for research management and governance for all the Norfolk PCTs and Waveney PCT. It also provides research administration to the Suffolk and Norfolk Research and Development Group.

Norfolk Public Health Network

Great Yarmouth PCT is part of Norfolk Public Health Network, with Norwich PCT as the lead organisation.

Medicines Management Priorities Group

Great Yarmouth is part of the Therapeutics Advisory Group, which has representation from primary and secondary care and the community health council. This group discusses common prescribing issues and provides advice to the local health community.

The Director of Public Health from Great Yarmouth PCT oversees the NICE implementation fund on behalf of the 7 PCTs in Norfolk and Waveney, which reimburses NHS Trusts the additional costs of introducing NICE recommendations. He chairs the county "Therapeutics Advisory Group" which develops prescribing policy across Norfolk and Waveney and oversees the introduction of new medicines.

Norfolk Prescribing Team

Great Yarmouth PCT is represented on the pan Norfolk Prescribing Team. All PCTs from Norfolk are represented on the Team and Broadland PCT hosts the group.

Drugs and Therapeutics Committee

The Prescribing Advisor from Great Yarmouth PCT attends the James Paget HealthCare NHS Trust Drugs and Therapeutics Committee.

Cancer Network

Great Yarmouth PCT is part of the Norfolk and Waveney Cancer Network. This includes all the PCTs in Norfolk plus the acute trusts (James Paget Healthcare NHS Trust and Norfolk and Norwich University Hospitals NHS Trust).

Coronary Heart Disease Network

Great Yarmouth PCT is part of the Anglia Cardiac Network. This includes all the PCTs in the Cambridgeshire, Norfolk, and Suffolk Strategic Health Authority (SHA) plus 8 acute Trusts within the SHA.

Commissioning Network

Great Yarmouth and Waveney health system have established the Eastern Cluster Modernisation Board which comprises representatives of:

- James Paget Heathcare NHS Trust
- Norfolk Mental Health Care NHS Trust
- Great Yarmouth PCT
- Waveney PCT
- Norfolk and Suffolk's social care departments

Diabetes Network

Great Yarmouth PCT has joined with Waveney PCT and James Paget Heathcare NHS Trust to form The Diabetes Local Implementation Team Group (LIT) for Great Yarmouth and Waveney area.

Mental Health Network

Norfolk and Waveney Mental Health Partnership NHS Trust provides mental health services to Great Yarmouth PCT

Specialist Services Commissioning Network

Suffolk West PCT has recently become the host for the new core team that will support the collaborative commissioning of acute specialised services on behalf of the 17 PCTs, including Great Yarmouth PCT.

Trafford South PCT

Commissioning Network

Trafford South PCT is involved two two types of commissioning relationships:

- Trafford South PCT has some services provided by South Manchester University Hospitals Trust. and works collaboratively with South Manchester PCT and South Manchester Hospitals .

- Trafford South PCT is part of the Greater Manchester PCTs Collaborative Commissioning Programme. This was established in the autumn of 2002 and involves each PCT taking a lead role in commissioning on behalf of all 14 Greater Manchester PCTs. The Collaborative Commissioning Team is funded by contributions from all of the GM PCTs and works on their behlaf to support cordinate and assure the quality of their commissioning activity. Bury PCT is the lead PCT for the Programme as a whole.

Coronary Heart Disease Networks

Trafford South PCT is part of the Greater Manchester and Cheshire Cardiac Network. This includes all the PCTs in the Greater Manchester SHA and Central Cheshire and Eastern Cheshire PCTs as well as the acute Trusts in greater Manchester and Mid Cheshire Acute NHS Trust and East Cheshire Acute NHS Trust.

Cancer Network

Trafford South PCT is part of the Greater Manchester and Cheshire Cancer Network.

Mental Health Network

Trafford North PCT has the lead responsibility for the commissioning of adult mental health services for Trafford North and Trafford South PCTs. Trafford North and South PCTs are the Lead PCT for Mental Health Services for the Greater Manchester Primary Care Trusts. Bolton, Salford and Trafford Mental Health NHS Trust provide Adult Mental Health Services to Trafford South PCT.

Medicines Management Network

Trafford South PCT is part of the Greater Manchester Pharmaceutical Advisers and Chief Pharmacists Group.

Public Health Network

Trafford South PCT is part of the Greater Manchester Public Health Network, with Ashton, Wigan and Leigh PCT taking the lead on behalf of the other PCTs.

Research and Development Governance Group

Trafford South PCT is part of the Salford Research and Governance Group. The PCT's involved in this group are: Salford PCT (Host), Trafford South PCT, Trafford North PCT, Heywood and Middleton PCT and Rochdale PCT.

Diabetes Network

Heywood and Middleton PCT is the Lead PCT for Endocrine Services for the Greater Manchester Primary Care Trusts. Trafford South and North PCTs, and Trafford Healthcare NHS Trust work together to form the Local Implementation Team.