This is a summary of changes announced by NHS England/Improvement, in consultation with BMA GP committee England, for the PCN DES (directed enhanced service).
NHSE/I has now published an amendment to the network contract DES for 2020/21. This applies from 1 October 2020 to all practices who are signed up to the DES.
There are three major changes:
- increased flexibility for the clinical lead under the enhanced health in care homes service requirements to be a non-GP
- the introduction of two new reimbursable roles under the ARRS (additional roles reimbursement scheme)
- the introduction of the IIF (investment and impact fund).
Enhanced health in care homes clinical lead
The amended DES permits the clinical lead under the enhanced health in care homes service to be a non-GP clinician with appropriate experience of working with care homes. This is likely to be the case only in exceptional cases and will need the agreement of the practices in the PCN, the CCG and the relevant community provider.
The additional roles reimbursement scheme
Nursing associates will be reimbursed up to a maximum annual reimbursable amount of £29,135 per FTE.
Trainee nursing associates will be reimbursed up to a maximum annual amount of £25,671 per FTE.
Both are subject to the role meeting the minimum requirements set out in the DES.
Introduction of the IIF (investment and impact fund)
The fund was postponed until 1 October 2020, but of the £40.5m funding originally earmarked for the IIF, £16.25m has already been allocated to PCNs through the PCN support funding stream. This is paid on the basis of a PCN’s weighted population at 27p per weighted patient for the six month period to 31 September 2020.
The remaining £24.25m will be available to PCNs to earn through the fund and will run until 31 March 2021. It will resource PCNs in their response to COVID-19, particularly around preventative work on cohorts at risk of poor health outcomes.
The IIF is an incentive scheme and will be worth £24.25 million in 2020/21, rising to at least £150 million in 2021/22, £225 million in 2022/23 and £300 million in 2023/24.
It will operate in a similar way to QOF, with each indicator allocated a certain number of points. For 2020/21, each IIF point will be worth £111 and there will be a total of 194 points available to each PCN.
The six indicators for 2020/21, with associated points and thresholds, are set out in the table below.
| Indicator description | £m | Points | Lower threshold | Upper threshold |
|---|---|---|---|---|
| % 65+ who received a seasonal flu vaccination | 9 | 72 | 70% | 77% |
| % on learning disability register who received learning disability health check | 5.875 | 47 | 49% | 80% |
| % referred to social prescribing | 3.125 | 25 | 0.4% | 0.8% |
| % 65+ prescribed NSAID without gastro-protective | 4 | 32 | 43% | 30% |
| % 18+ prescribed oral anticoagulant & antiplatelet without gastro-protective | 0.75 | 6 | 40% | 25% |
| % 18+ prescribed aspirin and another anti-platelet without gastro-protective | 1.5 | 12 | 42% | 25% |
| Total | 24.25 | 194 |
Auto-enrolment and opt outs
Since April 2020, new auto-enrolment provisions have been included in the DES. This means practices and PCNs do not need to submit any further information to their CCG to confirm their acceptance of the revised terms and future years’ specifications.
However, if a practice does not wish to accept the revised terms, and wishes to opt out of the network contract DES, it must inform its CCG of its decision to opt out by 17 October. The terms of the network contract DES will no longer apply to the practice from 18 October.
Table of network contract DES financial entitlements
| Payment details | Amount |
|---|---|
| Core PCN funding | £1.50 per registered patient per year (£0.125 per patient per month) |
| Clinical director contribution | £0.722 per registered patient per year (£0.06 per patient per month) |
| Staff reimbursements | Actual salary plus employer on-costs to the maximum per WTE amounts as outlined in network contract DES specification |
| Extended hours access | £1.45 per registered patient (£0.121 per patient per month) |
| Care home premium | £60 per bed for the period 1 August 2020 to 31 March 2021 (£7.50 per bed per month) £120 per bed per year from 1 April 2021 |
| PCN support payment | £0.27 per weighted patient for 1 April 2020 to 30 September 2020 (£0.045 per weighted patient per month |
In addition to the payments made to the PCN’s nominated payee under the terms of the network contract DES, participating practices will be entitled to the network participation payment (£1.76 per patient).