Practices will form Primary Care Networks through a new Network DES, thereby building on the core contract. Networks will facilitate shared decision making between practices for their total network populations (typically 30-50,000), around funding and workforce distribution, and augmented service provision. Networks will need to be geographically contiguous.
Additional workforce will be introduced and partially-funded through the Network. The number will build up over the five years, so by 2024 there should be an additional 22,000 staff in primary care, as follows:
- From 2019, each network should be able to employ one clinical pharmacist and one social prescriber.
- From 2020, funding will increase to enable the additional employment of first contact physiotherapists and physicians associates.
- From 2021, all of the above will increase and community paramedics will be introduced.
- From 2022, all of the above workforce will be increased so that by 2024 a typical network will receive 5 clinical pharmacists (equivalent of one per practice), three social prescribers, three first contact physiotherapists, two physicians 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. The exception is social prescribers, which NHS England will fund 100% including on-costs.
The network will decide how the additional workforce is employed (ie by a single lead practice, by an organisation (eg a Federation or community trust) on behalf of the network, or different professionals employed by different practices within the network).
The workforce and network will be led by a Clinical Director, chosen from within the GPs of each network. This Clinical Director will be funded – an average of a day a week for a network of 40,000 patients (including on-costs) from new funding provided by NHS England.
Network requirements and services
To become a network, practices will need to complete a short submission to the CCG as part of the DES. This will require the names and codes for each practice within the network, the total network list size (ie sum of member practices’ lists), a map marking the network area, the name and details of the single provider to receive funding, the name and details of the clinical director, and the initial Network Agreement (signed by each practice).
The network agreement outlines what decisions the network has made about how they will work together, which practice will deliver what (for specific packages of care), how funding will be allocated between practices, how the new workforce will be shared (including who will employ them) etc. This agreement may be amended/update over time with the agreement of member practices, and as new services, workforce and funding become available.
Requirements (and associated funding) for the Extended Hours Access DES (currently undertaken by practices) will move to the Network, which will be responsible for ensuring the equivalent coverage for 100% of the network population. Increasingly, and by 2021 for all areas, this activity will be aligned with the evening and weekend services currently funded in each area of the country through £6 per patient and all will be under the direction of the network. This will enable a more integrated service with local practices.
From 2019, the DES specification will require networks to outline how data will be shared within the network.
From 2020 onwards, additional requirements will be added around specific support for those in care homes, undertaking medication reviews, improving personalisation and anticipatory care, cancer care, prevention and inequalities, and CVD; although the details of these are still to be negotiated. These areas will be linked to the expanded workforce employed by the network.
In addition to the workforce costs (for the additional workforce and the clinical director) each network will receive a recurrent annual payment of £1.50 per patient (an extension of the current CCG funding, but now non-discretionary) to be used by the network practices to support their work. Additional funding has also been added to global sum, for practices to establish and engage with networks.
Front-loaded additional funding, ring-fenced for networks, will be available from central allocations (in addition to some of the current funding for GPFV and CCG funding).
A new Network Investment and Impact Fund will be introduced from 2020, providing funding for networks successful in reducing the burden on secondary care, in a controlled and agreed manner and which could be used by the Network to develop more sustainable community based services.
See further details on Networks, funding streams, requirements, services and how to prepare.
Primary Care Networks (PCNs)