An introduction to clinical networks

Friday, March 13, 2020

We have so many networks in healthcare these days, so you would be forgiven for asking “what exactly are Strategic Clinical Networks? And how do they improve care?” Here, Gareth Lord takes us through a little history and context.

The evolution of clinical networks

Clinical networks originally began life as the simple idea of sharing knowledge and good practice.

Back in the 1990s, even before the name clinical networks began to be used to describe them,  clinicians from different organisations, mostly hospital trusts used to come together to discuss ways to improve care for specific conditions, particularly those that resulted in high mortality. Early days saw these meetings revolve principally around heart disease, cancer and stroke.

Eventually, these meetings and collaborations became more regular and organised, and became the first Managed Clinical Networks (the Cardiac Networks, Cancer Networks, and Stroke Networks). In the process, they gained formal clinical leadership and project management support.

By the early 2000’s, Managed Clinical Networks were “promoted” to non-statutory bodies that advised and assisted commissioners and senior management on clinical policies, pathways, and innovations to improve care. New ones were formed to preside over large areas, often the size of a region or county, and were usually hosted by a local Primary Care Trust. Managed Clinical Networks used national and regional priorities to guide their work, and looked at local unwarranted variations to advise on service improvement programmes in their region.

Due to their early success, they grew in number and evolved into more complex entities. The 2000’s saw clinical networks expand to cover specific cohorts such as children, functions such as critical care and specialties such as vascular surgery. However, because they often arose from local demand, their remit, funding, staffing and individual programmes still varied considerably.

With the NHS reform of 2012/13, Managed Clinical Networks were recognised as a regional asset and they were provided with a new and more formal structure. From that point onward, independent cardiac, stroke, cancer networks etc., were grouped together under a single NHS funded organisation: Strategic Clinical Networks (SCNs).  The function of these Networks was similar to the Managed ones, but with an emphasis on was strategy rather than delivery, and they maintained their collective aim of aiding commissioners in achieving the objectives of the NHS Outcomes Framework. 

In the years that have since passed, SCNs such as the Greater Manchester one, have extended further into other disciplines and areas, to incorporate Palliative and End of Life Care, and more recently Respiratory disease. With the main difference being that their aim is to aid in the local delivery of the 5 year plan and that of the NHS Long Term Plan.

The difference between networks

What distinguishes Strategic Clinical Networks from other networks that have been established over the years is the clinical leadership and the focus on clinical strategy. In a way, the term ‘clinical network’ slightly undersells their value, as it doesn’t reflect the fact that SCNs regularly work with a wide and diverse range of organisations and institutions beyond clinical, to be able to do their work.

As an example, a SCN will need to liaise with service users, commissioners, NHS management, public and population health professionals and bodies, the pharmaceutical industry, NHS Rightcare, Business intelligence, the 3rd sector, NHS England and NHS Improvement, as well as possibly other networks!

There are Operational Delivery Networks (ODNs), which are designed to coordinate patient pathways and ensure access to specialist resources, such as critical care beds or burns units.  Academic Health Science Networks (AHSNs) connect NHS and academic organisations, local authorities and industry with the aim of identifying and spreading health innovation at scale. There are also smaller local CCG clinical networks, with a similar remit of the strategic ones, but which are only there to address specific priorities within a single CCG area.

More recently, since 2018-19, you will have heard of Primary Care Networks (PCNs). These are collaborations between local GP practices, community, mental health services, social care, pharmacy, secondary care and voluntary services, to deliver an integrated care service to relatively small communities (30-50,000 people based on GP lists).

The idea behind PCNs is that being local and looking after smaller groups of patients, they are strategically placed to delivering Integrated Care services to their population based on their actual needs, rather than following a standard England-wide plan.

Strategic clinical networks and integration

The very nature of the SCNs is conducive to the integration between primary and secondary care, different organisations, and of professionals from different disciplines striving to achieve the same goals.

The role I see them play in continuing to promote the adoption of integrated care models is to co-ordinate and support people and organisations in order to help shape programmes and initiatives.  They can act as brokers and mediators, thanks to their ability to connect different people and offer clinical strategy, direction and guidance to aid both clinical practice and commissioning decisions, locally and at scale, in a fair and unbiased way.

But of course, it isn’t all rosy. Just as networks have evolved, so has the healthcare landscape.

In GM we are fortunate enough to have a SCN sitting at the top table of the Greater Manchester Health and Social Care Partnership, which greatly facilitates collaboration, but in other areas it’s not so simple.

For example, some SCNs cover multiple Integrated Care Systems, each likely to have their own regional priorities and ambitions. Where these additional challenges exist SCNs may have to reconfigure their resources, or seek additional ones where required.

However, by far the biggest challenge any SCN face at some point, is the lack of authority and power.  They remain, at present, advisory bodies, which means local care organisations can still, should they choose, ignore the advice and guidance offered by SCNs and act of their own accord.

There are several ways SCN’s could overcome these challenges, but by far the most effective solution would be for Integrated Care Systems to embrace them and embed them into their strategic decision making architecture.