The vast majority of practices (99.5% according to NHS England) have signed network agreements and are therefore part of a primary care network (PCN). But how exactly will funding for networks work?
NHS England has promised a lot of new money that, it says, will help transform general practice. It has calculated that by 2023/24 a typical network covering 50,000 people will receive up to £1.47m via the network contract DES. Are there catches though? And what does it mean for individual practices?
What is the money for?
The new funding is tied closely to the delivery of the goals set out in the NHS long-term plan and this will involve moving more services and treatments for patients in a primary care setting – a lot of these services will fall under the auspices of GPs.
PCNs will have responsibility for delivering seven national service specifications set out in the contract, namely:
- Structured medicines review and optimisation (from 2020/21)
- Enhanced health in care homes (from 2020/21)
- Anticipatory care (from 2020/21)
- Personalised care (from 2020/21)
- Supporting early cancer diagnosis (from 2020/21)
- Cardiovascular disease prevention and diagnosis (from 2021/22)
- Tackling neighbourhood inequalities (from 2021/22).
Apart from the enhancd health in care homes, which has been piloted as part of NHS England's vanguard programme, it is not exactly clear what these services will involve – that wlll be the subject of ongoing contract negotiations between NHS England and the BMA. But it should be obvious to GPs that this is not a give-away and NHS England is looking for its pound of flesh for the extra money they will be spending.
What we do know about these services is that PCNs will be expected to deliver against an agreed set of ‘standard national processes, metrics and expected quantified benefits for patients’. The devil will be in the detail no doubt. For the current year, formation of PCNs is the goal but five of these seven services will be commissioned from 2020/1. Time to make ready and get as much of the detail as possible.
In order to give GPs a chance to provide these new services, there is an acceptance that new staff will likely be required and hence the Additional Roles Reimbursement Scheme which is supposed to help pay for five new roles:
- Clinical pharmacists
- Social prescribing link workers
- Physician associates
- First contact physiotherapists
- First contact community paramedics.
Practices must be clear that this is a reimbursement scheme and not money up front. The reimbursement level is not set at 100% of costs (apart from the social prescribing roles) so technically these roles will be a cost to GPs.
The money itself
Some £1.8bn of the extra £2.8bn promised additional funding for general practice over the next five years will flow through the network contract DES. Once again, the devil is in the detail; money will increasingly flow to the PCN and not practices:
|Funding streams||Funding per patient|
|Core PCN funding||£1.50|
|*payment per weighted payment, all other payments are per registered patient|
This calculation applies to those practices that were undertaking the extended hours DES. It is fairly simple arithmetic and, while the funding for participation in the network DES is per weighted patient and funding for PCNs is per registered patient, the point is worth making – for some practices, income will go down.
Note the comments above about the Additional Roles Reimbursement Scheme monies as well. Because the reimbursement level is not a universal 100%, how the difference will be made up could prove a tricky issue in the early days of PCN formation.
The conclusion is that GPs should not assume that, having joined a PCN as mandated, money will now flow to them directly. Increasingly the money will flow directly to the PCN and this means that GPs will need to have arrangements in place for both managing this and for governance purposes.
While it is true that practices in England have increased their level of collaboration with neighbours in recent years, this really is something new. The stakes have been raised because co-operation no longer relies on simple goodwill and instead has a significant monetary component.
The new services will further test the level of co-operation because they will need to be provided collectively if they are going to operate efficiently. If this is the ‘storming and norming’ phase, then there is much to be done.
- John Tacchi is a partner in Tanza Partners, a health consultancy which specialises in primary care