What is a primary care network?
Each primary care network (PCN) will bring together a group of neighbouring GP practices to cover a population of 30,000 to 50,000 patients. The networks are expected to provide support to member practices, benefiting from economies of scale as they collaborate to provide services and with an expanded primary care team - including shared staff across the networks - taking pressure off GPs.
Guidance published by the BMA on PCNs suggests they should be 'small enough to still provide the personal care valued by both patients and GP practices, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system'.
How will networks be funded?
A directed enhanced service (DES) implemented from 2019/20 under the new five-year GP contract deal will provide a package of funding to support the creation and staffing of networks, along with a template network agreement to underpin how practices work together.
A full DES specification will be published in March, ahead of the start of the 2019/20 financial year. Most funding for the scheme will be paid to a nominated provider within each network - which could be one of the member practices, or a federation representing the network.
Practices will receive a payment for 'network engagement' directly through their global sum, with all other funding going through the nominated provider. Contract documentation says that a typical practice will receive over £14,000 each year from April 2019 'in return for their initial and then continued active participation in a primary care network'.
Networks will receive £1.50 per patient to cover administrative costs, on top of payments for elements including staff, a clinical lead and extended access.
Each network will receive recurrent funding from 2019/20 onwards to cover the full cost of hiring a social prescribing link worker, and 70% of the cost of a pharmacist - with further funding in subsequent years for additional staff.
£31m will be available nationally to fund a clinical lead in each network at the rate of 25% of the average full-time GP salary per 50,000 patients - effectively a day's time for the GP taking the post. Networks will be funded from 2020 to take on work including care home support, early cancer diagnosis, medicines reviews and more.
From 2019/20 the existing extended hours DES will be transferred into network funding, offering £1.45 per patient in 2019/20, with networks absorbing from 2020 the £6 per patient in access funding delivered through the GP Forward View.
Do GP practices have to join a PCN?
As with all enhanced services, practices are not obliged to take part. However, more than half of new funding available to practices through the five-year contract deal agreed between NHS England and the BMA is linked to engagement with networks.
If practices choose not to join a network this funding will be unavailable to them - and the network covering their area will deliver some 'network-level services' to their patient population. This could include enhanced services, which will be awarded through networks rather than to individual practices in future.
What should practices do now?
GP practices are advised to start talks now with neighbouring practices about forming a primary care network, and will be expected to submit a plan to their local CCG by the end of April setting out their list size, geographic area, nominated provider to receive payments and naming a clinical lead from among the member practices.
Full details of the DES specification will be published by 29 March, which will further clarify the exact details practices will be required to provide.
How will staff arrangements work?
Practices in each network can choose how they wish to appoint a clinical lead, and will simply have to explain what the process was when they submit details to their CCG.
Staff funding provided through the network arrangements cannot generally be used to cover the cost of existing staff, and are intended to encourage networks to expand their teams.
However, where pharmacists are employed through the existing clinical pharmacists in general practice scheme or the pharmacists in care homes scheme, for which funding was intended to reduce over time, funding for these staff can be covered by funding available under the network DES.
Networks will receive full funding in 2019/20 - as described above - for a social prescribing link worker and 70% funding for a pharmacist, with further funding for staff in subsequent years.
By 2024, NHS England expects that a typical network will have five clinical pharmacists (equivalent of one per practice), three social prescribers, three first contact physiotherapists, two physician associates and one community paramedic.