Expanded PCN incentive scheme includes new targets for online consultations and prescribing

NHS England has introduced new targets for the number of online consultations practices should conduct from October, as part of a significantly expanded incentive scheme for PCNs.

Incentives for online consultations (Photo: Luis Alvarez/Getty Images)

The updated Investment and Impact Fund (IIF), which is voluntary, also introduces incentives for practices to switch patients from pressurised metered dose inhalers to more environmentally-friendly alternatives. 

A new indicator will see PCNs achieve points if practices within the network conduct five online consultations per week, per 1,000 patients, from 1 October onwards.

NHS England guidance accompanying the IIF says that this will ensure 'that online consultations continue to be offered to patients consistently across the country as we exit the pandemic, relieving pressures on wider services as part of the recovery programme'.

PCNs will also face targets for reducing the number of patients who wait longer than two weeks for an appointment from April 2022. The indicator for online consultations will remain in place during 2022/23, although the level of appointments that must be provided online has yet to decided.

PCN incentive scheme

Meanwhile from April 2022 PCNs will also be rewarded for 'improvements in patient experience of access to general practice, though financial incentives linked to performance in relation to the forthcoming survey-based realtime measure of patient experience', the guidance says.

The IIF, which works in a similar way to the QOF but at a PCN level, has been significantly expanded since initial guidance for this year was published in March as part of a wider overhaul of what NHS England expects from PCNs.

This week NHS England also announced that two of the controversial service specifications that were due to start in October have been deferred until April 2022, while two other services have been significantly stripped back.

The IIF has been expanded from an initial six indicators across two domains that were worth up to 225 points from April 2021 to 19 indicators across four domains that are worth up to 666 points from October.

While the scheme is voluntary it will be worth £150m in total in 2021/22 and £225m in 2022/23 meaning that networks could miss out on significant amounts of additional funding if they don't take part.

Access targets

One of the new domains introduced this year focuses on access, which includes the indicators for online consultations this year and waiting times next year. 

Other indicators in that domain this year ask practices to map all appointment slot types to the new set of national appointment categories and to increase referrals to the Community Pharmacist Consultation Service by the end of March 2022.

Meanwhile, a new domain on sustainability sets targets for practices to reduce the proportion of pressurised metered dose inhalers they prescribe 'as a percentage of all non-salbutamol inhaler prescriptions issued on or after 1 October'. NHS England is currently aiming for just 25% of non-salbutamol inhalers prescribed across the NHS to be MDIs by 2023/24.

NHS England said that it would provide additional guidance to help clinicians have conversations with patients about switching, adding that research suggested most asthma patients using MDIs would change device for environmental reasons as long as the new inhaler was as effective as their current medication.

New indicators

Other additions to the IIF for this year link to work that PCNs will be expected to do for the stripped back service specifications that come into effect from October 2021. For example those relating to hypertension mirror the CVD prevention service requirements and the learning disability indicator links to requirements in the tackling neighbourhood health inequalities service.

New care home indicators in the IIF relate to the enhanced health in care homes service specification that was introduced last year.

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