GPs must join a Primary Care Network to be eligible for enhanced funding
Primary Care Network Contracts – Key points
- New Network Contract DES (Directed Enhanced Service) introduced as the mechanism for flowing additional funding to primary care
- GP Practices have until 15 May 2019 to sign up to the Network Contract DES by completing and returning their PCN registration
- Practices are not obliged to join a network, but those outside will not be eligible for a share of the £1.799bn funding
- Once approved by the CCG, all member practices will need to sign the mandatory PCN agreement. Whilst this is in a non-negotiable standard form, it does contain various schedules which are to be populated specific to the requirements of each particular PCN
- It is vital that practices think through the detail to go into the schedules with care, to ensure they have a clear legal agreement on which to rely when PCN decisions have to be made.
Introducing the new Network Contract DES
The concept of a primary care network is far from new. Structures similar to those that will result from the new PCN contracts have been developing for some time. What is new is that NHS England is now mandating the Network Contract DES (Directed Enhanced Service) as the mechanism for flowing additional funding to primary care. Practices are not obliged to join a network, but those outside will not be eligible for a share of the £1.799bn that will flow through the Network Contract DES by 2023/24. Furthermore, the BMA has clarified that the new GP contract requires that every patient must be covered by a network, even if their practice does not join one.
The challenge for the NHS is well recognised: how to care for an ageing population, with more patients living with long-term conditions and preventable disease, with limited resources. The media tend to characterise the main consequence of this as pressure on hospital beds, but actually it is in general practice that the challenge manifests itself first and foremost. So, how do we best support primary care to allow it to deliver services closer to the patient’s home, and create other options for accessing care so that patients don’t always need to see a GP? The PCN is thought to hold the answer. This initiative is not about creating a network of small practices but rather about supporting all practices to work with the wider health economy for the good of the local population.
NHS commissioning is moving to a population-centred approach, and the logic of a PCN is clear. Benefit should accrue from reviewing the health needs of a local population, then designing services to meet the needs, and of course GP practices have long been at the heart of healthcare delivery to their local populations. The PCN recognises that GPs cannot do this alone, so it must bring together health and social care professionals working collaboratively in locally-led and managed teams. PCNs will be expected to include community pharmacies, optometrists, dental providers, social care providers, voluntary sector organisations, and community or local government service providers.
How will practices contract with each other?
NHS England has now published the Specification (for the first year), Guidance and mandatory form of Network Agreement to be adopted, with the aim of achieving 100% geographical PCN coverage from 1st July this year. The guidance says that “PCNs will increasingly need to work with other non-GP providers, as part of collaborative primary care networks, in order to offer their local populations more personalised, coordinated health and social care”. This collaboration with non-GP providers will be a requirement of the Network Contract DES from 2020/21. The guidance also requires commissioners to consider how other services can be aligned with the PCNs in the future.
There has been concern that the widening of networks could mean that GPs might no longer be at their heart. The PCN specification recently confirmed that networks must be led by a “clinical director” who will be a “practising clinician from within the PCN member practices”, whereas the original intention was for them to be led by a “GP”. The specification says “It is most likely this role will be fulfilled by a GP”, but goes on to say that “this is not an absolute requirement”. The guidance does confirm that “general practice must remain at the core of the networks”, and that PCNs will be expected to be “led by groups of general practices”. Furthermore, the specification confirms that “Payments under the Network Contract DES will be made into the bank account of the single nominated practice or provider (who holds a GMS, PMS or APMS contact)”.
With PCNs coming from a practice-led process, and 88% of practices already part of a network (as at October last year), it is clear why NHS England now back them as the delivery vehicle for the enhanced funding. All practices wishing to join a PCN should be given the opportunity, and no patient should be left without PCN coverage. This will require CCGs (and, where applicable, NHS England Regional Teams) to work closely with LMCs to support PCN formation and development at a local level. The guidance requires that “During June 2019, this collaborative working will focus on resolving any issues and supporting practices in forming PCNs and signing up to the DES. LMCs will bring practices in their area together, mediate where required and help ensure 100% coverage”.
Criticism has been levelled that PCNs are sure to add further bureaucratic burden to practices, nevertheless it is hard to see practices not signing up. For any non-participating practices, the PCN will take on the responsibility of the Network Contract DES for their patients, with funding for those patients flowing to the PCN through a locally-commissioned agreement.
What are the terms of the new Network Agreement?
The new national Network Agreement now issued by NHS England has been developed to support the Network Contract DES and PCNs, and its use is mandatory. It sets out the collective rights and obligations of GP providers within the core of the PCN, and its use is required to claim collective financial entitlements under the Network Contract DES. It also sets out how practices will collaborate with non-GP providers making up the wider PCN. In due course, a data-sharing agreement template will be provided and entering into one of these will also be a requirement.
As mentioned, the specification issued with the mandatory agreement is for the first year only: this is seen as a ‘development year’. From April 2020, seven new national network service specifications will be introduced to the Network Contract DES, to contribute to the implementation of the NHS Long Term Plan. These will cover medications review, health in care homes, anticipatory care, early cancer diagnosis, personalised care, CVD prevention and diagnosis, and neighbourhood inequalities.
Also from April 2020, there will be a “Network Dashboard” to include information on population health and prevention, urgent and anticipatory care, prescribing and hospital use. This will also provide information on the new network service specifications, with the aim of showing PCNs the benefits they are achieving for the local community and patients.
Practices have until 15 May 2019 to sign up to the Network Contract DES by completing and returning their PCN registration. This requires identification of practices with whom they plan to form a network. Once approved by the CCG, all member practices will need to sign the mandatory PCN agreement.
Whilst this is in a non-negotiable standard form, it does contain various schedules which are to be populated specific to the requirements of each particular PCN. They cover things such as the PCN’s decision-making process, who does what in relation to PCN activities, financial arrangements, arrangements for funding of additional staff, what happens on member insolvency, and arrangements with organisations outside the network.
As always ‘the devil is in the detail’: getting the information in these schedules correct will be key to the success of the network, and the detailed arrangements may prove difficult for practices. It does, however, provide the flexibility needed to allow practices to tailor it to how they want to work. It is vital that practices think through the detail to go into the schedules with care, to ensure they have a clear legal agreement on which to rely when PCN decisions have to be made.