Primary care networks

Primary care networks

What is a primary care network?

A Primary Care Network is a grouping of GP practices within a geographical area, typically covering a population of 30,000-50,000 people.

From July 2019, it is expected that all areas of England will be served by a PCN, and indeed, 99% of practices have joined one.

The Networks can be structured a number of ways, with the decision on how a respective Network operates down to agreement between its practice membership. They are designed to be GP-led and only GP practices can set up PCNs.

In the future PCNs are expected to become a larger more inclusive primary care team, with practices expected to work with Community Trusts, the voluntary sector and other agencies.

The BMA suggests that they should be ‘small enough to still provide the personal care valued by both patients and GP practices, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system’.

How will they work?

Recurrent, national funding has been made available to PCNs through a direct enhanced service (DES).

This is designed to expand the overall primary care workforce in an attempt to reduce GP workload.

Commissioners are expected to supplement this with local arrangements.

The DES funding will provide 70% of monies for a practice pharmacist and 100% of a social prescriber salary, from the Additional Roles Reimbursement Scheme.

There is also allocated funding of £1.50 per patient to support networks and 0.25 whole time equivalent funding for a clinical lead for each network.

Extended access responsibilities and funding will also be handled by PCNs. This equates to £1.45 per patient.

This may increase to £6 per patient in 2020 if the GP Forward View ‘Improving Access’ monies and responsibilities are also transferred.

What are their responsibilities?

PCNs will be responsible for all in-hours primary care work and extended access.

New responsibilities will also be rolled out from 2020. Potential funding for the following areas has been suggested:

• Medications review and optimisation
• Enhanced health in care homes service
• Anticipatory care
• Personalised care
• Supporting early cancer diagnosis
• Cardiovascular disease prevention and diagnosis
• Reducing health inequalities

From 2020-2021 PCNs will be expected to assess risk of ‘unwarranted health outcomes’ and work with community services to support people most in need.

The data for this work should be provided by the local Integrated Care System.

CCGs commission the network to provide services, via the DES. How the services are delivered across the network is up to the network.

How decisions are made is also determined by the network (for example, majority vote, CD discretion, unanimity) – the number of votes or weighting for each practice may be determined by the network (for example based on practice list size, or one vote per practice)

Other organisations (community trusts, voluntary organisations) may be invited to join the network, but the network will decide how governance structures account for this (for example, should they get an equal vote, what do those organisations bring)

From April 2019 practices have been required to:

• Provide new patients with full online access to prospective data from their patient record (using/referring to national NHS Login identity verification)
• Reserve appointments for NHS 111 clinicians (not lay call handlers) to book patients into.

This will be 1 appointment per day, per 3,000 patients (rounded down, with a minimum of 1)

For example 1500 patients = 1 appointment

5900 patients = 1 appointment

6001 patients = 2 appointments

During 2019, practices will need to prepare to:

• Register a practice email address with MHRA CAS alert system to act on CAS alerts where appropriate
• Register a mobile phone number(s) to MHRA CAS to be used only as an emergency back up to email by October 2019
• Make at least 25% of appointments available for online booking by or on behalf of a patient by July 2019 (with GP, nurse, pharmacist, or paramedic/healthcare assistant)
• Offer online consultations by April 2020
• Offer and promote electronic ordering of repeat prescriptions and using electronic repeat dispensing for all patients for whom it is clinically appropriate by April 2020
• Provide all patients with access to online correspondence by April 2020
• No longer use fax machines for NHS work or patient correspondence by April 2020
• Ensure they have an up-to-date and informative online presence by April 2020
• Provide all patients with online access to their full record including the ability to add their own information from April 2020

What practical steps (should) have been taken?

Practices need to begin discussions locally and potentially use existing clusters, federations and neighbourhood arrangements to start the process of becoming a PCN.

If practices decided to sign up to the DES as networks they need to have submitted the following information to their CCG:

• The names and the Organisation Data Service (ODS) codes of the member practices
• The PCN list size, that is the sum of its member practices’ lists from 1 January 2019
• The PCN Agreement signed by all member practices
• The named practice that will receive funding on behalf of the PCN
• A named Clinical Lead/Director from within the GPs of the PCN
• A map marking the PCN area

Timeline for the first year

1 July 2019: Network DES goes live

July 2019 – March 2020: National entitlements under the 2019/20 Network Contract start: year 1 of the additional workforce reimbursement scheme; ongoing support funding for the Clinical Director; ongoing £1.50/head from CCG allocations

Potential benefits of PCNs

The following have been described as possible benefits of PCNs

• Improving the ability of practices to recruit and retain staff
• To manage financial and estates pressures
• To provide a wider range of services to patients
• More easily integrate with the wider health and care system
• Improving the quality of services provided

Potential problems of PCNs

The following have been suggested as potential problems of PCNs

• Distracting clinicians away from clinical care
• Not a proven model
• Reduced local access for some patients as practices merge
• Loss of continuity and trusted local relationships
• Risk of big business/private buy out of primary care services
• Complexity and scale challenges
• Risk of financial loss for practices as some posts are not fully funded

What happens next?

The new GP contract documentation was published in April 2019, clarifying some of the more technical issues around how networks could be formed

Money is expected from July 2019.

Test-bed sites will be developed to test elements of the new contract, new service specifications will be developed and written, and the innovation and investment fund designed.

There are many questions which are unanswered, including what developmental support will be available for networks as they seek to implement new roles and services.

Summary

During this module you have learnt

The proposed structure of primary care network (PCN)

How they will work

What their responsibilities are and might be in the future

The practical steps involved in setting up a PCN

The timeline involved

The potential benefits of PCNs

The potential problems of PCNs

ACTIVITIES

• Find out the arrangements for your own practice

• Who are the other members of your network

• Arrange a meeting with other practice nurses in the network to discuss issues such as overcoming professional isolation, sharing resources, mentoring and clinical supervision, and arranging network-wide continuing professional development

Resources

NHS England Primary Care Networks case studies https://www.england.nhs.uk/gp/case-studies/primary-care-networks-the-building-blocks-of-an-ics/

The King’s Fund Primary Care Networks explained https://www.kingsfund.org.uk/publications/primary-care-networks-explained

RCGP Primary Care Networks https://www.rcgp.org.uk/primary-care-development/primary-care-networks.aspx

Pharmaceutical Services Negotiating Committee PCNs https://psnc.org.uk/the-healthcare-landscape/primary-care-networks-pcns/

GP Online What do plans for primary care networks mean for GPs? https://www.gponline.com/plans-primary-care-networks-mean-gps/article/1524412

BMA The Practice Blog PCNs https://www.bma.org.uk/connecting-doctors/the_practice/b/weblog/posts/primary-care-networks-pcns

BMA website guidance on GP contract: http://www.bma.org.uk/gpcontractengland

HM Government GP partnership review https://www.gov.uk/government/publications/gp-partnership-review-final-report

HSJ Primary Care Networks – the new show in town needs a second act https://www.hsj.co.uk/primary-care/the-commissioner-primary-care-networks--the-new-show-in-town-needs-a-second-act/7022303.article

Nuffield Trust Is bigger better? Lessons for large-scale general practice https://www.nuffieldtrust.org.uk/research/is-bigger-better-lessons-for-large-scale-general-practice