Primary Care Networks – Implementing the First Year National Entitlements
With the 30th June deadline firmly behind us, and with the basic infrastructure of individual Primary Care Networks (PCNs) established in the form of a signed Network Agreement, PCNs can now focus attention on the development of the network, namely implementing the first year’s national entitlements.
These entitlements cluster around the additional workforce strategy and assist with business and financial planning.
To start with, there is the £1.50 per head of population entitlement, based on the agreed network list size as of 1st January each year. This is being categorised as core PCN funding and supports the general administration costs of the network. The funding is taken from Clinical Commissioning Group (CCG) allocations and ultimately how this funding is utilised will be for the network collectively to decide.
The first payment is due at the end of July 2019, being backdated to the 1st April 2019, then monthly in arrears. This financial schedule will underpin the business and financial strategy over the coming months and years.
A word of caution here: with networks very much in the early delivery stage, the broad remit attached to core funding and a wealth of providers vying for a slice of the pie; funding could be quickly and easily be eaten up by paying back fill for board or management meetings, outside consultancy services, legal fees etc… Having a solid business and financial strategy from the start will allow the network to make efficient use of the various funding streams available ultimately enhancing patient care and contributing to the success of the network.
On top of the £1.50 allocations, each network will receive funding for a named accountable Clinical Director. The Clinical Director should be a practicing clinician from within the member practices but does not need to be a GP, and - depending on the size of the network and agreed sessional rate - the role should generally be funded between 1-2 sessions per week.
The remit of the Clinical Director is to provide strategic and clinical leadership, including development of the network workforce strategy, work with member practices to improve the quality and effectiveness of network services, develop relationships and work closely with other Network Clinical Directors as well as representing the network at CCG-level clinical meetings, thus shaping the wider landscape of the Integrated Care System (ICS).
With such a comprehensive remit in terms of roles and responsibilities one may wonder if Clinical Directors can accomplish what is being asked of them in the finite amount of funded time. In recognition of this, some PCNs have elected to appoint a network or Lead Manager funded from the £1.50 per head to provide administrative and management support to the Clinical Director.
However, more than this is needed in order for the Clinical Director to deliver the priorities of the network. Member practices need to take an active role by providing the Clinical Director with a clear picture of the networks population health needs. This is best done by avoiding a lengthy list of problems but helping to identify solutions. Therefore, regular attendance and involvement at board or network meetings is essential and also decisive as voting will allow the Clinical Director to carry forward the networks priorities.
Finally, the workforce reimbursement scheme whereby PCNs are entitled to claim, in the first year, direct reimbursement of 70 per cent for a Clinical Pharmacist and 100 per cent for a Social Prescribing Link Worker to help deliver additional network health services. How the remaining 30 per cent is funded is up to the network, with some member practices agreeing to fund the shortfall and others utilising the £1.50 per head monies.
It’s useful to note that the maximum reimbursable amount for each of these roles will be set at the weighted mid-point of the respective Agenda for Change salary band. Also, from April 2020, direct reimbursements for each of these roles will be replaced by an ‘additional roles’ sum for each network which will be based on the practice’s weighted patient population.
With only 9 months of the financial year left, it is imperative that networks have a good understanding of the two roles and have a recruitment process in place with the job adverts ready to post, if not already done so. The recruitment and selection process takes time and with other local and regional PCNs actively recruiting, the pool of these two roles will be diminishing.
The two roles are, relatively speaking, new to general practice and it will be interesting to see how networks utilise the additional workforce to deliver network health services.
General Practices have accomplished a great deal in such a short period of time and from 2020 there will be the potential for additional funding for delivering the seven national service specifications which will be phased in gradually over the next 5 years.
To get to that point, it is critical that member practices continue to support their Clinical Director and work with them to deliver and build on network health services over the next 9 months.