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Explained: primary care networks and their role in the long term plan


By Rachel Carter
15 January 2019

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The long term plan, published last week, reaffirmed NHS England’s commitment to bringing neighbouring GP practices together under one single network.

A move towards primary care networks was signalled in the 2014 Five Year Forward View and in some areas of the country these are already up and running.

However, the long term plan has now made it mandatory for all individual practices to join a network going forward.

Here’s what we know so far on how the networks will work in practice:

How will the networks be set up?

According to the long term plan, individual practices will enter into a network contract through a set of ‘multi-year’ contract changes.

The network contract will be an extension of practices’ current contracts and there will be a designated fund for all network resources. Any local contracts for enhanced services will normally be added to the network contract.

A new ‘shared savings’ scheme will be set up, offering primary care networks (PCNs) the chance to benefit from actions taken locally to reduce avoidable A&E attendances, admissions and delayed discharges, as well as from the streamlining of patient pathways to reduce avoidable outpatient visits and over-medication through pharmacist review, the plan says.

The plan adds that PCNs will typically cover between 30,000 and 50,000 patients.

Previous reports published by NHS England state that covering a combined patient population of this size will allow practices to share community nursing, mental health and clinical pharmacy teams, as well responsibility for urgent care and extended access.

A revised quality and outcomes framework for GP practices will also support this way of working. The least effective indicators will be scrapped and a new quality improvement element added.

How will the networks work in practice?

The long term plan pledged an extra £4.5bn for primary and community care services by 2023-24 and says this new investment will fund expanded community multidisciplinary teams.

These teams will be aligned with new PCNs and will be made up of a range of staff including GPs, pharmacists, district nurses, community geriatricians, dementia workers and physiotherapists, as well as social care and voluntary sector staff.

‘In many parts of the country, functions such as district nursing are already configured on network footprints and this will now become the required norm,’ the plan says.

From 2020-21, the networks will be expected to assess their local population by ‘risk of unwarranted health outcomes’ and work in partnership with community services to make support available to people who need it most.

This will include continuing to use the electronic frailty index to routinely identify people living with severe frailty.

How will networks interact with the wider health system?

The expanded PCN teams will support ICSs, which bring together health and social care organisations.

ICSs are expected to be central to the delivery of the long term plan and should be working across the country by April 2021.

This year the NHS 111 service will start booking appointments directly into GP practices across the country and PCNs will also work with emergency services more widely to provide emergency support, including out-of-hours advice.

NHS England’s enhanced health in care homes vanguards will also be rolled out everywhere by 2023-2.

This, the plan states, will create stronger links between PCNs and their local care homes, with all care homes supported by a consistent team of healthcare professionals, including ‘named general practice support’.

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