The shifting primary care landscape – primary care networks

Significant changes to the shape of the NHS primary care landscape are in progress with the roll out of primary care networks or PCNs.  The NHS Long Term Plan sets out the vision of achieving a triple integration of primary and specialist care, physical and mental health services and health and social care, and the PCN agenda forms part of this.  PCNs comprise groups of GP practices who are to enter into a formal legal agreement (a network agreement)  to confirm how they are going to work more closely together over the coming months and years.  Each PCN is typically likely to have a collective patient population of between 30,000 and 50,000 patients (although they can be larger).   The intention is that each part of the country is covered by a PCN (usually without overlap), and the boundary of each PCN should make sense in terms of healthcare provision both to the local community, and also to the GP practices themselves and local community providers.  Each GP practice will continue to run core primary care services through their own NHS primary care contract, however it is the additional activities framed principally through the new network contract DES that will be delivered through the PCN structure.

Significant new funding streams will be made available to PCNs to fund their networks and services, under the network contract DES.  To be eligible to form part of a PCN, and therefore to be entitled to the new network contract DES, an organisation will need to be a holder of an in hours (essential) primary medical services contract (whether that is a GMS, PMS or APMS contract).  NHS England estimate that a PCN with 50,000 patients will be entitled to up to about £180,000 during the 2019/20 financial year if it takes advantage of all the reimbursements and funding streams available.    These funding streams include (for 2019/20) 100% funding for the engagement by the PCN of an additional social prescriber, and 70% funding for the engagement by the PCN of an additional clinical pharmacist.   Each PCN is also required to have a named Clinical Director who is accountable overall for the delivery by the PCN of the network contract service specifications and entitlements, with money being made available towards the funding of this post.

In order to be eligible for the network contract DES, practices need to register the PCN with its local Clinical Commissioning Group by mid-May, and the constituent practices of the PCN need to have entered into a network agreement to confirm how they are going to collaborate together by the end of June 2019.  Whilst the front end of the network agreement is in standard form, its schedules will include the detail of the collaborative arrangements, including areas such as the proposed shared workforce arrangements, the role each practice and other relevant organisations play in the delivery of these plans, how the funding will be managed and distributed, and how decisions within the PCN are made.

The network contract envisages that each PCN will work closely with their local community health providers and other relevant providers (although no financial entitlements will be set for these working arrangements during the next 12 months).  There is therefore good opportunities for relevant third party healthcare providers to engage with their local PCNs at an early stage, and possibly become a party to the relevant PCN network agreement and take a seat on the governing body of the PCN.   There are also good opportunities for existing GP federations and NHS providers to provide services to PCNs to help facilitate their joint working arrangements, such as the recruitment of workforce on behalf of the PCN and the provision of training.

PCNs will need to carefully consider their structure and operating model, taking into account key factors such as how the additional workforce is to be employed, and how liability for this workforce and liability for performance of the network contract is to be shared amongst its members.  An existing GP federation corporate structure already in place for the PCN constituent members could potentially be used as a vehicle for the relevant PCN.  However such entity could not sign up to the DES or receive funding directly unless it holds a primary medical services contract in its own right.

There are also other key structural considerations to take into account including NHS pension scheme eligibility and the VAT implications of the proposed charging arrangements.