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Five things you need to know about the primary care network structure


By Valeria Fiore
Reporter
18 March 2019

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The NHS long-term plan, published in January, revealed that primary and community services will get a funding boost of £4.5bn a year by 2023/24 to ensure more people are looked after closer to home.

Primary care networks (PCNs) are groups of practices working with other health and care organisations and are set to play a crucial role in the delivery of the long-term plan’s ambitions.

PCNs will contribute to integrated care systems’s (ICSs) discussions and plans, driving the delivery of integrated primary care at community level.

Given the rising importance of PCNs, the BMA has published a primary care networks handbook to offer guidance to practices on how to set up PCNs.

CCGs are expected to make sure their entire population is covered by PCNs by July. What do commissioners and local leaders need to know to correctly set up PCNs?

  1. Practices will take the lead

NHS England envisages the creation of PCNs to be a bottom-up process, with general practice taking the lead in their formation.

CCGs will still play a crucial part in commissioning the new PCN contract. This is a directed enhanced service (DES) that will be backed by financial investment to help PCNs secure the additional workforce and services they will be required to provide, according to the BMA.

Commissioners and local medical committees (LMCs) will need to work together to make sure practices ‘lead and direct’ PCNs.

LMCs will also need to ensure PCNs are engaged at system level with ICSs and sustainability and transformation partnerships (STPs) ‘to shape their strategic direction and improve and align population care on a wider scale’, the BMA said.

  1. CCGs are to plug gaps in coverage

Every patient needs to be covered by a PCN by July and CCGs need to make sure no one is left outside of a PCN.

Typically, the BMA said, PCN member practices would decide what area to cover after discussions with colleagues from neighbouring practices.

The only instance in which CCGs can intervene in the process is ‘when there are gaps in the total PCN coverage of their area’, according to the BMA.

If this happens, CCGs need to collaborate with local LMCs. They would act as middlemen between the PCN and practices that are not part of it, making sure network-level services are offered to patients who wouldn’t otherwise be covered by a network.

  1. Practices will need to make joint decisions

GP practices will need to make joint decisions on a number of issues in order to be recognised as a PCN.

These include deciding on their network’s size and area, for instance. Member practices also need to sign a copy of an initial network agreement, name a clinical director, and select a practice that will receive the funding on behalf of the PCN.

The network agreement, which will need to be updated on a yearly basis to reflect changes in funding or workforce allocations, needs to address how practices will deal with network-specific issues.

These include decision making and funding distribution arrangements between the different practices, and workforce related decisions – including the appointment of the clinical lead.

Commissioners will not be able to challenge the content of the network agreement. The BMA said: ‘As long as the practices have agreed, the CCG cannot refuse the DES based on its content.’

  1. Funding will be transferred to the networks

Each PCN member practice will receive a network engagement funding; an annual payment of £1.76 per patient for engagement with the primary care network scheme which is up to the individual practice to decide how to use.

A nominated provider – named in the network agreement – will receive funding under the DES.

This includes:

  • A network payment. Networks will receive £1.50 per patient from CCG central allocations
  • Extended hours funding. The current extended hours DES will transfer to the network, which will received £1.45 per patient
  • Extended access funding. This funding will also transfer to the PCN over time, the BMA suggested. Depending on current arrangements, CCGs might start making the transfer from 2019 but NHS England said that all extended access funding should have transferred to each network by 2021
  1. CCGs can give networks additional funding

Commissioners cannot decrease or remove the funding entitlements for networks, the BMA said, buy they can add money to it.

Networks could also decide to provide additional remunerated services ‘beyond the national specification’ after discussions with the CCG.

The BMA said: ‘This funding could then be used to cover the network’s 30% workforce contribution, or even to recruit additional staff that could be used by the network and its constituent practices.’

In the future, commissioners can choose to transfer locally commissioned services contracts to the network, the BMA added.

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