In a letter to GPs sent on 24 August, health leaders confirmed that four PCN service requirements would not be introduced in full from October 2021 as originally planned. Instead, two services will begin in October: cardiovascular disease (CVD) prevention and diagnosis, and tackling neighbourhood health inequalities, but in a 'reduced' form.
PCNs will not be asked to start work on the personalised care service until April 2022, while the anticipatory care service will begin in September 2022. NHS England said this would give PCNs the ‘maximum possible time to prepare’.
The letter also revealed that PCNs will be able to access 'significant funding' through the Investment and Impact Fund (IIF), effectively a QOF for PCNs, across the second half of 2021/22 - but the ‘main implementation focus’ will begin in 2022/23.
PCN services
The decision follows calls from the BMA last week that PCN targets should be deferred after NHS England admitted GPs are working 'harder than at any time in their history'.
BMA leaders said the plans to push back PCN work to next year were a ‘positive sign’ but warned that practices must be given additional ‘support, flexibility and resources’ to deliver care in the difficult months ahead.
NHS England's letter said: ‘Taking into account the immediate pressures on general practice we are now setting out a plan for the gradual introduction of new service requirements for PCNs and confirming how PCNs will access the significant funding available for their activities through the IIF across the second half of 2021/22 and 2022/23.’
For the CVD service PCNs will now be required to focus on improving hypertension case finding and diagnosis from October this year. Similar requirements for atrial fibrillation, familial hypercholesteremia and heart failure that were due to be part of the service will now be introduced from April 2022.
For the health inequalities service, from October PCNs will need to identify and engage a 'population experiencing health inequalities within their are and to code sign an intention to address the unmet needs of this population'. Work on delivering this intervention does not need to begin until March 2022.
Investment and Impact Fund
From April 2022, PCNs will also be asked to deliver a single, combined extended access offer funded through the Network Contract DES. NHS England says it intends to publish details on this in the autumn, prior to beginning in April 2022.
The letter also confirms that the majority of new IIF incentives will be aligned to five focus areas, with most of the indicators in 2021/22 supporting preparatory work towards the PCN service requirements or the introduction of full performance indicators in 2022/23.
NHS England previously revealed that the IIF would be worth £150m to PCNs for 2021/22 and £225m for 2022/23. It has also announced ew funding of £43m in 2021/22 to support PCN leadership and management.
The funding will be allocated on the basis of the CCG primary medical allocation formula - making adjustments for unmet need in areas of higher deprivation. Crucially, clinical directors will be responsible for recommending how the funding is used to create new capacity in support of the work of PCNs.
Workload pressures
BMA GP committee chair Dr Richard Vautrey, said: 'Given the intense pressure that practices continue to be under – even in the middle of summer – we have persistently called for the additional services to be delayed beyond October.
'It’s positive then to see that NHSEI has begun to listen to the BMA by pushing back these service specifications, and providing additional funding for PCN leadership. Following recent pronouncements about its gratitude to general practice and its recognition of just how hard GPs and their colleagues are working, it is now a positive sign that this change in tone beginning to be backed up with more tangible action.'
He added: 'Of course, even with the specifications deferred, this winter will still be incredibly difficult for all working in general practice, and we need assurances that individual practices, as well as PCNs, will be given all of the support, flexibility and resources needed to care for their communities in the coming months.'
PCN leaders told GPonline earlier this year that they required additional funding to train and integrate new staff recruited through the additional roles reimbursement scheme - arguing that there was no payment for backfilling time taken out from clinical work.
Responding to the PCN plans, NHS Confederation PCN Network Dr Pramit Patel said: 'The introduction of dedicated funding for management resource is long overdue and will enable PCNs to put in place a more robust management infrastructure necessary to oversee the increasing amount of responsibility they are being given.'
