General Practitioners Committee

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Creating and running primary care networks (PCNs)

The creation of PCNs is dependent on several factors, such as: geography, a network agreement, the appointment of a clinical director and establishing and enabling sustainable networks.

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Pre-requisites to becoming a PCN

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.

Networks will need to complete a network agreement. The intention is that this will be a pro forma agreement with 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 regarding 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).

The network agreement will have to be updated year on year as new services, workforce and funding are added. The content of the network agreement is not within the remit of the CCG to challenge. As long as the practices have agreed, the CCG cannot refuse the DES based on its content.

Blog: PCN registration completed – what’s next?
Blog: The right structures for Primary Care Networks (PCNs)

 

PCN handbook

The BMA have 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; it is advisable to read the whole of the document (including the amendments at the end) before meeting with others to make decisions. 

Download the handbook

Read our PCN top tips

PCN planning calendar (PDF)

 

Governance

Whichever organisational structure that practices chose to develop for their network, they will need to ensure that there are robust and appropriate governance structures in place. In doing so, practices will need to consider several key questions regarding how they wish the network to operate on a day-to-day basis. 

Governing/ representative body – this will help to set out a clear decision-making process, they will need to identify relevant agents to act on behalf of Network members.

Decision-making – this process will need to cover what is in the remit of the clinical director, how decisions are made, how often the governing body meets and how these are chaired.

Accountability – clear lines of accountability should be agreed and established from the outset.

Data sharing – data sharing agreements will need to be set up between the constituent practices, as well as any non-GP organisations that are party to the network, this is to allow all parts of the network to access the necessary patient data. Read more on data sharing below.

Dispute resolution – clear dispute resolution procedures will need to be in place to ensure disagreements are resolved appropriately.

Finances – depending on how the network is constituted, governance procedures should set out how the Networks finances are handled.

HR policies – HR policies will apply to staff employed under the network.

Non-practice partners – Networks will need to consider how they interact with other healthcare bodies, in preparation for close working relationships that develop with other primary and community care organisations.

 

Data sharing

NHS England and the BMA have agreed on a non-mandatory, high-level data sharing template for use by PCNs. To make things simpler for practices, the BMA has also produced a version of the agreed template which expands on a number of areas with greater detail, along with guidance on the document. This provides practices with a better idea of how they may wish to populate the template agreement, including proposed best practice when sharing and transferring data between partners within the network.

The template and the guidance have been drafted for the BMA by Mills and Reeve. It should be noted that neither the template nor the guidance constitute legal advice and are intended only as a guide to be adapted as required. When completing the template agreement it is recommended that practices receive appropriate professional advice.

Download our data sharing guidance

Download the template

 

Guidance on decision making

The following documents have been created to assist the decision making for the network agreement schedule 1 part 7. 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.

The more detailed version, example 2, 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. 

We recommend that you carefully read through both documents and note that these are indicative provisions, so we cannot guarantee their suitability to all practices.

Download - Example 1

Download - Example 2

 

PCN schedules – deadline 30 June to complete

PCNs must decide for themselves the information to include in each schedule and how they fit together. Read our new guidance on completing the PCN schedules, which includes information about each and their interdependencies.

PCN schedule guidance

 

Funding

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. Practices will also receive a separate payment through the SFE in return for signing up to the DES.

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, tied to the development of community-based services that enable reductions in hospital activity, such as accident and emergency attendances, delayed discharge and avoidable outpatient visits.

 

Workforce

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 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 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.

Guide to social prescribing: In January 2019, the BMA GPC (England) and NHS England agreed plans to fund social prescribing link workers for PCNs in England, as part of the GP contract agreement. NHS England aim to recruit up to 1,000 link workers by 2020/21, who will be directly embedded within PCNs.

This guidance has been drafted to help GPs make the most of the social prescribing schemes they refer patients to, and collaborate with link workers who will, from July 2019, join their extended primary care teams

Download our guide to social prescribing

 

Tax guidance

When developing a PCN, practices will need to be very careful that the structure they choose does not inadvertently attract VAT charges. To help guide initial discussions and future considerations for practices, we commissioned two guides on the potential VAT considerations of two of the most common models of PCN; the 'lead practice model' and the 'federation model'. Further information on these models are available in the BMA’s PCN handbook.

VAT and PCN funding for GP federations

VAT and PCN funding for lead providers

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.