What is the plan?

16 December 2014
Volume 30 · Issue 5

Nilesh Patel considers the future of LPNs.

You may have read my previous opinions on networks, their strengths, their weaknesses and the opportunities. I am generally supportive of networks as they provide an opportunity to start conversations, generate ideas and progress innovation. With the right set of members, common purpose and resource they are good mechanisms to aide co-production and co-commissioning. Networks have the potential to bring the right people together and get them talking to each other.

 

The three orphans of the health service, dentistry, optometry and pharmacy have all been challenged to develop local professional networks. This has been an interesting journey so far and no doubt it’ll continue to become more interesting with time. Within dentistry, some of you may be aware of the existence or absence of your local professional network. What seems to have emerged is a pick ‘n’ mix bag of different arrangements across England.

 

Some local professional networks have clearly defined terms of reference whilst others have less clearly defined terms of reference. I am not sure that this matters as much as first determining the scope of the network and how they should operate. As often happens in the health service, committees are formed by deciding who should be around the table before identifying the function they are supposed to be discharging. This same calamity can be seen with some local professional networks, where they are still deciding who should be members before identifying their purpose.

 

The word ‘local’ features in their title which helps add some more confusion to this bag of pick n mix. Who decides what is local? Is local a reference to the convenient boundaries of a local area team? Is it based on population density? Is it based on a geographic or administrative boundary? Or is it based on the population and communities? The reason this question needs to be resolved is because the reach of the network and their ability to influence change and development will be limited by their boundaries and the resource they have within those boundaries.

 

The payment structure for network chairs is another peculiarity that again takes dentistry in a different direction to the rest of the health service. In some places the resource allocation is somewhat embarrassing and could even be seen as nothing short of insulting. Chairing a network requires time and support, it’s not simply holding a meeting but also all the activity between the meetings (the business of the network). There may be a lot of goodwill around the table but this is not sustainable and unrealistic in the long term. Network chairs within other strategic clinical networks are generally paid on a sessional basis for those that relate to primary care medicine. Within dentistry, adverts seem to have emerged on an agenda for change pay scale, which arguably could be seen as defying the normal practice of contracting with doctors and dentists in healthcare. Those LPN chairs who are NHS consultants may even have administrative support and it’ll be interesting to reflect in a year’s time whether there is a difference in outcome between those who are employed with support, compared to those who are from primary care under a different mechanism.

 

The membership of networks varies greatly around England and in different places the decision making processes seem to vary hugely as to who decides on membership. In some areas, members are invited whilst in other areas membership is determined by advert. This can also result in very different compositions of LPNs. There are also those LPNs where there are only very few members, (the local commissioning lead, the chair and perhaps a consultant in dental public health). This raises the question of whether this is truly an LPN or whether it’s simply an internal NHS England meeting structure.

 

Over the last month many LPNs will have submitted their plan on a page to the senior ranks in NHS England. Putting aside how this fits into the governance structure for NHS England, it remains to be seen whether these plans will be compared and whether they will be made readily available to the public. This national ‘conference’ of LPN chairs seems to have emerged and aligned itself to the national office of NHS England, some may view this as national control over what is theoretically a ‘local’ network. What remains less clear is how a local professional network with only one or two identified members can have a plan and if they do, who and how these plans are determined.

 

In my view local professional networks do still have the opportunity to drive change, but they need development, support and resourcing. They also need guidance and nurturing; and a mechanism to encourage innovative chairs but also to make use of experience.