What? Another NHS Publication? This One Matters Lots

The GP contract agreement announced this week has already been hailed as one of the most significant changes to general practice arrangements and will introduce widespread changes aimed at addressing   workforce and workload pressures facing primary care.

The package includes a deal covering the next five years with various changes going live throughout the five years. This year, yes 2019, the focus will be on creating Networks and to start workforce expansion. Next year will bring further workforce expansion, additional funding and service reconfiguration under the new networks. Change starts to happen from April 2019 with more support and resources for general practice, increased funding and assuring GP’s leadership role at the centre of primary care.

There have already been several similarly “big” announcements recently and more detail is set to follow.  However, it is fair to say that, alongside the recent publication on the NHS Long Term Plan, this makes a lot of bedtime reading.

In this explainer, we’ve picked out our top five things you may want to know from the initial headlines. What do they may mean for primary care? What are the implementation challenges and what are the opportunities? Maybe also take a few minutes to watch the BMA’s Richard Vautrey in a short video explainer. This gives you great highlights – only 7 minutes of your time.

Top five takeaways

1. Primary Care Networks are important. Very important. 

In the NHS Long Term Plan, Primary Care Networks are cited as being ‘an essential building block of every Integrated Care System’, and under the Network Contract Directed Enhanced Service (DES), general practice takes the leading role in every Primary Care Network (PCN). Happily, general practice continues to be fundamental to the future of primary care. The creation of PCNs is a key feature of the new contract. A highlight being that additional workforce and linked funding will be available through the new PCNs. Hurrah. How much and for how long I hear you ask.

2. There’s additional funding for GPs – through PCNs (see, said they were important!) 

Big numbers follow. Like overall funding of £2.8bn over a five-year period, through practices and networks. In addition to workforce costs (for the additional workforce and the clinical director – don’t worry we’ll come onto that) each network will receive a recurrent annual payment of £1.50 per patient (an extension of the current CCG funding, but now non-discretionary). That will be used by the network practices to support their development and work. Additional funding has been added to the global sum, for practices to establish and engage with networks.

If every network takes up 100{e980883acf09aa6731d266ddff51021f2e88fc440f2f33096f8e3067dd947694} of the national Network Entitlements, including a recurrent £1.50/patient support, plus a new contribution to clinical leadership, £1.8 billion would flow nationally through the Network Contract DES by 2023/24. Double hurrah I hear you say. But what do you have to do for this money?

3. It addresses workload issues resulting from workforce shortfall  

Yes, it does say that. But insert own comment first, then read on. PCNs will be guaranteed funding for an up to estimated 20,000+ additional staff by 2023/24. The scheme will meet a recurrent 70{e980883acf09aa6731d266ddff51021f2e88fc440f2f33096f8e3067dd947694} of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics. And 100{e980883acf09aa6731d266ddff51021f2e88fc440f2f33096f8e3067dd947694} of the costs of additional social prescribing link workers.

By 2023/24, the reimbursement available to networks amounts to £891 million of new annual investment. Practices will continue to fund all other staff groups including GPs and nurses in the normal way through the core practice contract, which grows by £978 million of new annual investment by 2023/24 and will support further expansion of available nurse, GP and other staff numbers. I am sure you have a few questions about that including, what happens after five years. Leave that for now. We will return to it soon.

4. The new Network Contract DES for Primary Care Networks goes live from 1 July 2019

GPC England and NHS England are committed to 100{e980883acf09aa6731d266ddff51021f2e88fc440f2f33096f8e3067dd947694} geographical coverage of the Network Contract DES by the Monday 1 July 2019 ‘go live’ date. So, it goes without saying close working is needed between Clinical Commissioning Groups and Local Medical Committees to help ensure this goal is met. Those words could be described as being a bit of an understatement. Every practice will have the right to join a Primary Care Network in its CCG and have a right to participate in the Network Contract DES. A typical practice will receive over £14,000 each year from April 2019, in return for their initial and then continued active participation in a PCN as demonstrated by signing up to the Network Contract DES by 1 July 2019 and their subsequent participation.

5. There will be seven national service specifications 

You are probably worn out by now. But here is a little bit of detail you will need to read more about. (Watch this space). The increase in investment under this agreement includes the introduction of seven specific national service specifications under the Network Contract DES. These seven specifications give effect to most of the NHS Long Term Plan goals for primary care. PCNs are being encouraged to make early progress in each of these areas ahead of formal introduction of the requirements and will work to provide early detail of the evolving service specifications to facilitate that. The seven are focused on areas where PCNs can have significant impact against the ‘triple aim’. This includes improving health and saving lives (for example from strokes, heart attacks and cancer); improving the quality of care for people with multiple morbidities (for example through holistic and personalised care and support planning, structured medication reviews, and more intensive support for patients who need it most including care home residents) and helping to make the NHS more sustainable (for example, by helping to reduce avoidable hospital admissions). During 2019 and 2020, NHS England will develop the seven specifications and seek to agree these with GPC England as part of annual contract changes. Lots of detail here and more reading needed. Did you say you had trouble sleeping?

Final thoughts 

So, there you have it, some of the key highlights from the report. I’m sure you’ll continue to see further summaries as people continue to review if over the next few days. It’s also worth reading the report in full if you get a chance. We will be providing some meaningful perspectives over the coming weeks, incorporating real life views of practices and those coming together to work at scale already.

For me the big takeaway is collaboration and the need for practices to be proactive in formation, as well as acknowledging the important role of GP federations to support the formation and operation of PCNs. Quite simply the primary care sector needs to demonstrate new ways of working together. And whilst appreciate this is not a simple task, PCNs are going to be fundamental in the not too distant future. Read the bit on the above BMA link to see what you have to do next. Not much but lots of formation work is needed in short measure. We have done a lot of that recently you will be happy to know,

In my next blog we’ll look at how to overcome the challenges to create successful PCNs and the benefits they can offer primary care.

ATSCALE works with primary care to improve the way clinical services are provided. We also support change through collaboration, networks and neighborhood working. We do this through our work with commissioners, GP federations and GP practices across the UK to enable at scale working and to support the creation of primary care networks.

We see working with collaboration and merging practices as the future. Our team are working extensively precisely on this area of work. We’ve a great track record and see the results of at scale thinking with many practices. We are looking forward to the considerable challenge of delivering the ambitions of the PCN’s.