GP leaders have been urging NHS England to bring the way IIF funding is distributed to PCNs more closely in line with the way QOF payments work - delivering part of the funding upfront to support workload for practices throughout each year.
Practices receive the bulk of QOF funding each year upfront via a monthly ‘aspiration’ payment, with the balance paid through an 'achievement' payment after the end of each financial year.
PCNs, however, are currently paid for performance against IIF targets only through 'achievement' payments - the bulk of which come after the end of each financial year.
Investment and impact fund
Chair of NHS Clinical Commissioners and senior clinical advisor to the NHS Confederation Dr Graham Jackson said PCNs should be paid monthly to allow them to recruit the staff they need to begin IIF work.
The Buckinghamshire GP told GPonline: ‘This is a really big investment for PCNs. It's not going to be as easy as ticking a few boxes and getting the money - it's essentially a new QOF for PCNs. It's a shift in that direction - and PCNs should be thinking about building this into their baseline as an income, the same way that QOF is now baseline income for practices.
‘However, what it needs - and something which we have already had a conversation with NHS England about - is that the IIF needs to be paid aspirationally, like QOF is paid aspirationallly, so you get paid every month and then you receive a top-up at the end of the year. This would allow people to start spending the money on workforce to deliver this IIF.’
The IIF will be worth £150m to PCNs for 2021/22 and £225m for 2022/23, meaning IIF work is worth around £120,000 per average PCN in the current financial year and around £180,000 next year. A QOF-style aspiration-achievement split could see more than two-thirds of this paid upfront throughout each financial year.
NHS England has also announced extra funding worth £43m in 2021/22 to support PCN leadership and management.
Dr Jackson added that PCN leaders needed to be afforded the headspace to work out how they would carry out IIF. He said: ‘If clinical directors can get their head around a strategy of delivering IIF and work out what the workforce is to do that - and then if the aspirational payments come in - then it starts to become real money, but real money that has to be earned.
‘I also think it needs the headspace. That's the difficulty at the moment, there isn't the headspace to create the capacity to sit down and think: "How are we going to strategically approach this? What is the workforce we need to deliver this effectively?".’
Last month NHS England announced that PCN service requirements will be gradually phased in over the next 18 months - with just two beginning from October this year. The BMA this week accused the government of being disingenuous over indicators setting out targets for online GP consultations.