ABOUT

PCN SERVICES supports practices and primary care networks to implement the requirements for PCNs. We specialise in a range of services which can help practices to set up and run their PCNs. We have a team of clinical and practice advisers (Project Managers, GPs, nurses and practice managers), who have extensive experience of working with individual practices, federations, and CCGs. They understand the journey of developing and setting up PCNs and can therefore lend their support to others involved in organisational change.

Our services can help PCNs to meet the DES requirements, save on management costs and rapidly mobilise to start delivering care though their network.

WHAT WE CAN DO

We offer the following services to practices and clinical directors in PCNs

Advice, Support
and Consultancy

We can support you by providing all the necessary knowledge, guidance and consultancy in terms of organisation transition and mobilisation

Advance Technology Support

PCN SERVICES can help set up and manage online platforms for the networks. This can help members of the networks to communicate and share data. We can also provide a cloud based feedback system for patients and an online re-validation toolkit for GPs.

Workforce Recruitment,
Development and Training

Primary care networks can perform better with a well-trained and talented workforce. PCN SERVICES can assist the network in the recruitment of key staff, and provide training and development support.

Organisation Structure,
HR and Policies

PCN SERVICES can support you in setting up your legal entities, drafting constitution, appointment of clinical director, draft contract agreements and policies and provide guidance on decision-making processes.

Governance Accountability Systems, Financial Systems and Policies and Procurement

A PCN should have sound operating governance, robust accountability systems, and rigorous financial controls. The procurement of services should also follow due process. We can support an emerging PCN to develop these structures, put policies in place and mobilise and train staff to work with these systems and processes.

Patient Feedback

We can offer feedback technology solutions to GP Practices and PCNs, so they can engage with their patients, value their suggestions and make improvements to healthcare.

PCN DEVELOPMENT SUPPORT PACKAGE

1.1 BRANDING

We will design the branding theme of the PCN, providing them with logo designs, images, letterheads and business cards. Leaflets will be designed for the PCN to raise awareness of the role of the PCN in the community.

1.2 QUARTERLY NEWSLETTER

PCN SERVICES will offer to design 4 professional newsletters for the PCN in a year. These newsletters will be available both digitally and in print.

1.3 WEBSITE DEVELOPMENT & DESIGN

A PCN will be given its own website, content and hosting for the year. Staff members of the PCN will be given custom domain email addresses.

1.4 FILE SHARING CLOUD (FSC)

Members of the PCN will be given a cloud document system where they can login and share meeting minutes, policies, governance, financial reports and other notes related to their PCN.

1.5 PATIENT FEEDBACK SYSTEM

All member practices will be given a subscription for the whole year for an advanced patient feedback system based on the NHS England Friends and Family Test

1.6 GP REVALIDATION TOOLKIT

Doctors working in the member practices of the network will be offered an online revalidation toolkit to help them with their annual appraisal.

1.7 DATA SHARING AGREEMENTS

Support for compliance, data sharing and information governance.

1.8 ISO27001 ACCREDITATION SUPPORT

PCN SERVICES can help and support the PCN to achieve ISO 27001 standards in terms of cyber security, data handling and information sharing. ISO 27001:2013 is the internationally recognised best practice framework for an INFORMATION SECURITY MANAGEMENT SYSTEM (ISMS). It is one of the most popular information security standards worldwide.

1.9 CLINICAL DIRECTORS AND PCN WORKFORCE TRAINING

Leadership training and development for Clinical Directors and PCN workforce. We offer a range of leadership and management training courses accredited by the Universities of Oxford, Cambridge, Imperial College. Some of the courses are also accredited by the Faculty of Medical Leadership and Management.

PCN SERVICES can also offer:

  • a training needs analysis to highlight the development needs.
  • coaching focusing on organisational development and improving organisational performance involving group sessions and individual sessions in areas of coaching and mentoring skills, chairing skills, conflict resolution and developing action learning sets.
  • Use of 360s for performance, knowledge and skills review.

2.0 CLINICAL DIRECTORS FORUM

PCN Clinical directors will be invited to join the clinicaldirectors.com (a PCN SERVICES developed) forum. PCN Clinical Directors will be able to network and share good practice.

2.1 HR, PAYROLL, RECRUITMENT AND EMPLOYMENT CONTRACTS

PCN Services can develop bespoke employment contract documentation in the form of individual Principal Statements of Terms and Conditions of Employment for your various job types. A bespoke comprehensive Employee Handbook can be designed to meet the requirements of the PCN. This will assist you to manage a wide range of employment matters including recruitment, holiday and sickness control documentation.

On going HR contract can offer:

  • Unlimited access to us for advice on a 24 hour, 7 days per week basis to cover HR / employment law issues.
  • Unlimited e-mail access for HR advice during our normal office hours.
  • Telephone liaison with third parties such as employees solicitors or representatives on your behalf.
  • Confidential letter writing for such matters as discipline or grievance etc that arise from the advice service.
  • Regular updates to keep you abreast of developments in Employment and Safety Law.
  • Access to a wide range of templates, guidance documents and letters via a unique log in on our website.

2.2 ORGANISATION DEVELOPMENT AND STRATEGIC IMPROVEMENT PLANS

PCN Services can bring in expertise from population health management specialists, data experts familiar with Systm1/EMIS, CCG data etc, help you to shape a vision for your PCN and locality, set key performance targets and indicators for the PCN and help you to achieve efficiency and value for money for the services you are procuring. Using our PCN network and clinical directors forum we can help you to go and see good practice in other PCNs.

CONTACT US

INFORMATION ABOUT PRIMARY CARE NETWORKS

Primary care networks form a key building block of the NHS long-term plan. Bringing general practices together to work at scale has been a policy priority for some years for a range of reasons, including improving the ability of practices to recruit and retain staff; to manage financial and estates pressures; to provide a wider range of services to patients and to more easily integrate with the wider health and care system.

While GP practices have been finding different ways of working together over many years for example in super-partnerships, federations, clusters and networks the NHS long-term plan and the new GP contract, which will take effect in April 2019, put a more formal structure around this way of working, but without creating new statutory bodies.

All GP practices are expected to come together in geographical networks covering populations of approximately 30 50,000 patients by June 2019 if they are to take advantage of additional funding attached to the GP contract. This size is consistent with the size of the primary care homes, which exist in many places in the country, but much smaller than most GP Federations.

NHS England expects that most networks will be geographically based and will, between them, cover all practices within a clinical commissioning group (CCG) boundary. There are likely to be exceptions to this if there are already well-functioning networks which are not entirely geographically based, but this is not likely to be the norm. Some networks may cross CCG boundaries, and a practice may, in theory, belong to more than one primary care network. NHS England has expressed the view that 30,000 is a firm lower limit for population size, except in areas of extreme rurality, but the upper limit could be more flexible. NHS England is clear that the entire population must be able to access network-based services. While practices are not mandated to join a network, they will lose out on significant extra funding if they do not, and their neighbouring networks will be funded to provide services to those patients whose practice is not covered by a network. Where a single practice meets the size requirements of a network, they will be able to function as a network if the CCG agrees.

NHS England has significant ambitions for primary care networks, with the expectation that they will be a key vehicle for delivering many of the commitments in the long-term plan and providing a wider range of services to patients. Primary care networks will eventually be required to deliver a set of seven national service specifications. Five will start by April 2020: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. The remaining two will start by 2021: cardiovascular disease case-finding and locally agreed action to tackle inequalities. To do this they will be expected to provide a wider range of primary care services to patients, involving a wider set of staff roles than might be feasible in individual practices, for example, first contact physiotherapy, extended access and social prescribing. Networks will receive specific funding for clinical pharmacists and social prescribing link workers in 2019/20, with funding for physiotherapists, physician associates and paramedics in subsequent years. They will also be the footprint around which integrated community-based teams will develop, and community and mental health services will be expected to configure their services around primary care network boundaries. These teams will provide services to people with more complex needs, providing proactive and anticipatory care. Primary care networks will also be expected to think about the wider health of their population, taking a proactive approach to managing population health and, from 2020/21, assessing the needs of their local population to identify people who would benefit from targeted, proactive support. Primary care networks will be focused on service delivery, rather than on the planning and funding of services, responsibility for which will remain with commissioners, and are expected to be the building blocks around which integrated care systems are built. The ambition is that primary care networks will be the mechanism by which primary care representation is made stronger in integrated care systems, with the accountable clinical directors from each network being the link between general practice and the wider system.

Much of the new money for the NHS announced in June 2018 is directed at primary and community services, and a large proportion of this will be channelled through networks. The main funding for networks comes in the form of large directed enhanced services payment (DES), which is an extension of the core GP contract and must be offered to all practices. This will be worth up to £1.8 billion by 2023/24. It includes money to support the operation of the network and up to £891 million to help fund additional staff, through an additional roles reimbursement scheme. The contract is between the commissioner and individual practices, but receiving the money for the directed enhanced services payment is contingent on being part of the network and the money will be channelled through a single bank account directed by the network. Funding and responsibility for providing the enhanced access services, which pays GPs to give patients access to consultations outside core hours, will transfer to the network directed enhanced services payment by April 2021. In addition, a 'shared savings' scheme is proposed, under which primary care networks will benefit financially from reductions in accident and emergency attendances and hospital admissions. There will also be separate national funding to help primary care networks access digital-first support from April 2021, from an agreed list of suppliers on a new separate national framework.

The Additional Roles Reimbursement Scheme, part of the directed enhanced services payment contract, will fund 70 per cent of the cost of the specific new clinical roles, with the different roles coming in over the period of the contract, starting with clinical pharmacists and social prescribing link workers in 2019/20 (100 per cent of the cost of social prescribing link workers will be funded). In 2020/21 the scheme will be extended to include physician associates and first contact physiotherapists, with community paramedics added in 2021/22. The funding is intended to cover only new staff rather than existing roles. Networks will have the flexibility to decide how many of each of the types of staff they wish to employ.

Practices are accountable to their commissioner for the delivery of network services. Practices will sign a network agreement, a legally binding agreement between the practices setting out how they will discharge the responsibilities of the network. Primary care networks can also use this agreement to set out the network's wider objectives and record the involvement of other partners, for example community health providers and pharmacies, though these partners will not be part of the core network, as that can only be entities who hold a GP contract. It would be possible to remove a practice's entitlement to the directed enhanced services payment if the commissioner felt it was not delivering these services, in the same way a commissioner could remove a general medical services contract, though this is extremely rare. Each network must identify an accountable clinical director, although more detail is needed about how this role will operate in practice, and exactly what that accountability entails. At present, the main purpose of this role seems to be to provide a voice upwards to the wider integrated care system, and to be a single point of contact for the wider system, rather than to be accountable for the performance of the network or its constituent practices. The clinical directors will be appointed by the members of the network.

Previous research found that collaboration in general practice was most successful when it had been generated organically by general practices over a number of years, underpinned by trust, relationships and support, and where there was a clear focus and agreement on the role of the collaboration (for example, whether it was to share back-office functions, provide community services or for quality improvement). Collaborations were less successful where there was a lack of clarity of purpose or engagement or over-optimistic expectations. There are also some technical issues including high costs of shared information systems or complexities around financial liabilities and premises which might need to be addressed. Wales, Scotland and Northern Ireland have already implemented similar models which England can learn from. In Scotland, a key feature of the new GP contract has been the obligation to become part of a geographical quality cluster. These have been seen as variably successful, working well when they worked on similar quality improvement initiatives and less well when they covered a mix of urban and rural practices that faced different issues and had difficulties coming together to agree priorities. The Welsh health boards have also established clusters of practices: a Welsh assembly inquiry into their operation found evidence of good work but highlighted a concern that the cluster model may be over-reliant on key individuals and that professionals are not being included in cluster work as much as they should be. Primary care networks in England may need support to build the trust and relationships needed for successful collaboration, resisting attempts to be over-optimistic in what can be achieved in the short term. The scale and complexity of the implementation and leadership challenge should not be underestimated, and those leading primary care networks will need significant support if they are to deliver the ambitions set out for them.

Primary care networks have the potential to benefit patients by offering improved access and extending the range of services available to them, and by helping to integrate primary care with wider health and community services. Previous research on the impact of larger scale general practice on patient experience found mixed views. While some patients prioritise access above all else and are interested in the potential of larger collaborations to improve that access, others are more concerned about continuity and trusting relationships and are concerned these may be lost. Practices will need to work with their patient participation groups and the wider local community if they are going to address the needs of their local population.

The full GP contract documentation will be published by April 2019, and some of the more technical issues around how networks will be formed are likely to be addressed in this. GP practices have until the end of May to agree their network boundaries with their commissioners and the Local Medical Committee, and the first money is expected to flow from July 2019.Test-bed sites will be developed to test elements of the new contract, new service specifications will be developed and written, and the innovation and investment fund designed. There are many questions that remain unanswered, including what developmental support will be available for networks as they seek to implement new roles and services.