The creation of PCNs (primary care networks) is dependent on several factors, such as:
- a network agreement
- the appointment of a clinical director
- establishing and enabling sustainable networks.
PCN handbook and top tips
The BMA has created a handbook that provides advice to groups of practices looking to establish a PCN.
Most of the major elements are inter-dependent and so conversations and decisions should not be made in isolation.
You should read the whole handbook (including the amendments at the end) before meeting with others to make decisions.
What you need to become a PCN
Make a submission
To be recognised as a PCN, individual GP practices will need to make a brief joint submission outlining:
- the names and the ODS codes of the member practices
- the network list size (ie the sum of member practices’ lists as of 1 January 2019)
- a map clearly marking the agreed network area
- a copy of the initial network agreement signed by all member practices
- a named clinical director from among the clinicians in the network (additional funding is provided for this role)
- the single practice or provider that will receive funding on behalf of the PCN.
Complete a network agreement
PCNs will need to complete a network agreement. This will be a pro forma agreement that will be updated year-on-year. It should have schedules that can be moulded to enable the individual parties to specify how they will handle network-specific issues such as:
- decision making, governance and collaboration arrangements
- arrangements for the delivery of different packages of care
- the agreement for distribution of funding between the practices
- arrangements regarding the employment of the expanded workforce
- internal governance arrangements (appointment processes, decision making process, etc).
As long as the practices have agreed, the CCG cannot refuse the DES (direct enhanced service) based on its content.
The following documents have been created to assist the decision making for the network agreement schedule 1 part 7.
We recommend that you carefully read through both documents. Remember we cannot guarantee their suitability to all practices.
Example 1 is a simplified version, which covers decisions to be made by core network groups. This document indicates that each practice will nominate a practice rep who, together with the clinical director, will sit on the executive team.
Example 2, a more detailed version, also covers decisions by practices, all members and an operational committee.
The idea being that the operational committee handles day to day operations/running, the practice committee takes decisions of the core network practices, and the member committee takes decisions of all members.
NHS England and the BMA have agreed on a data sharing template for use by PCNs.
To make things simpler for practices, we have also produced a version of the agreed template which expands on a number of areas with greater detail, along with guidance on the document.
These do not constitute legal advice and you should seek professional advice when completing the agreement.
When developing a PCN, practices will need to be very careful that the structure they choose does not attract VAT charges.
To help guide discussions and future considerations for practices, we have produced two guides on VAT considerations of two of the most common models of PCN; the 'lead practice model' and the 'federation model'.
The information contained in these notes is intended as general guidance and prepared for information purposes only. It is not intended to provide financial advice. The advice and information which MHA Larking Gowen has provided to BMA, is for BMA’s sole use and not for any third party to whom BMA may communicate it, unless we have expressly agreed in our letter of engagement that a specified third party may rely on our work.
Neither MHA Larking Gowen nor the BMA accept responsibility to third parties to whom this engagement letter is not addressed, for any advice, information or material produced as part of our work for BMA which is made available to them.
Each network will receive an annual payment of £1.50 per patient.
Each practice will also receive £1.761 per patient through the SFE (statement of financial entitlements) when signed up to the DES.
Additional funding for networks, will be available in addition to the current funding for GPFV and CCG funding.
A new network investment and impact fund will be introduced from 2020. This is for the development of community-based services that reduce hospital visits.
Additional workforce will be introduced and partially-funded through the PCN. By 2024 there should be an additional 22,000 staff in primary care.
- From 2019: each network should be able to employ one clinical pharmacist and one social prescriber.
- From 2020: funding will increase for employment of physiotherapists and physician associates.
- From 2021: all the above will increase and community paramedics will be introduced.
- From 2022: all the above workforce will be increased so that by 2024 a typical network will receive five clinical pharmacists, three social prescribers, three physiotherapists, two physician associates and one community paramedic.
There will be some flexibility around numbers and professions within networks.
- NHS England will fund 70% of each professional including their on-costs.
- Networks will need to fund the additional 30% themselves.
- NHS England will fund social prescribers 100%.
- NHS England will fund clinical directors 100% (for an average of a day a week for 40,000 patients).
The workforce and network will be led by a clinical director, chosen from within the GPs of each network.
The network will decide how the additional workforce is employed. Options could be:
- by a single lead practice
- by an organisation (eg a federation or community trust)
- different professionals employed by different practices within the network.
Workforce and service provision guides
Guide to social prescribing
NHS England aim to recruit up to 1,000 link workers by 2020/21, who will be directly embedded within PCNs.
This guidance is to help GPs make the most of the social prescribing schemes they refer patients to and learn how best to work with link workers.
Engaging sessional GPs
This guidance provides advice to GPs, practices, PCNs, LMCs and federations on engaging with sessional GPs and ensuring they are represented in the PCN sphere.