In a letter to PCNs across an integrated care system (ICS) area covering north west London, obtained by GPonline, NHS leaders said that because PCNs are 'the unit of delivery moving forward' for NHS services, 'it is the intention of the ICS to be able to contract directly with the PCNs'.
NHS England has previously suggested that local enhanced services - also called local incentive schemes - could be commissioned at PCN level rather than from individual practices in future. However, contracting direct with the networks is not possible unless they become legal entities.
The letter to PCNs across north west London makes clear that it is the 'ICS expectation that PCNs will actively consider and work towards achieving legal entity status moving into 2022/23'.
On a national level, this change in legal status would pave the way for a colossal transfer of enhanced services funding - currently paid directly to individual practices - to PCNs. In 2019/20 alone, NHS Digital figures suggest that local incentive schemes were worth more than £511m across England.
BMA leaders warned GPs not to be pressured into changing the legal status of their PCNs - pointing out that practices have the right to choose how they operate and should not face pressure to adopt one format or another.
BMA GP committee chair Dr Richard Vautrey said: 'PCNs can set themselves up in a variety of different ways, one of which is as a legal entity.
'We know that some PCNs are already operating like this, with others considering it, but there is no intention to require PCNs to do this either from NHS England or the BMA. PCNs know how best to deliver care to their patients, so however they decide to operate is up to them.
Integrated care systems
'We would therefore, be concerned about CCGs or integrated care systems trying to force practices to do anything that they are not required to do, and that they have autonomous choice and control over.'
The letter to PCNs in north London says it is the first in a series concerning the 'roll out, implementation and delivery of North West London Enhanced Services Programme'. Contracts for local enhanced services relating to mental health and diabetes are being rolled out from 1 April, with six further services to follow from 1 July.
The letter says a recent 'stocktake' found multiple different contractual approaches - including CCGs contracting direct with practices, or with federations.
Although outcomes are already 'monitored at PCN level irrespective of the contracting architecture', from 2022/23 the letter makes clear that NHS leaders want PCNs to take on the legal status required to hold contracts at that level.
Primary care networks
The letter says: 'It is the ICS expectation that PCNs will actively consider and work towards achieving legal entity status moving into 2022/23. As legal entities PCNs have a lot of flexibilities including recruiting to new roles.
'They will also meet the ICS Standing Financial Instructions and be able to hold these contracts directly in future. Further discussions with respect to this will be planned during the course of the coming year. At this time, it is expected that the PCNs will come to a mutual agreement around the payment structures with individual practices.'
The BMA has told GPonline that it is not aware of similar pressure elsewhere in the country for PCNs to become legal entities. However, the NHS long-term plan in 2019 set out plans to shift commissioning of local enhanced services to PCN level. It said: 'Most CCGs have local contracts for enhanced services and these will normally be added to the network contract'.
Further NHS England guidance later that year, however, said: 'It will be for local commissioners to consider, and agree with their practices, whether there are current local incentive schemes that could more appropriately be delivered by primary care networks in future.'