The BMA’s GP committee for England backed a revised package of GP contract measures for 2020/21 on Thursday - just three weeks after rejecting an initial offer from NHS England.
Many of the problems relating to the initial offer from had been around NHS England's expectations of PCNs, in particular the draft service specifications that it consulted on over Christmas. So what has changed for networks and what does the contract deal mean for their future?
How has staff funding for networks changed?
All roles covered by the additional roles reimbursement scheme (ARRS), which provides funding for new staff employed by networks, will now be fully funded. The plan had been for social prescribers to be reimbursed for 100% of the cost, but other roles would only receive 70% funding. This would mean practices potentially contributing significant sums to the network by the final year of the five-year deal.
The ARRS had originally only planned to cover clinical pharmacists, social prescribing link workers, first contact physiotherapists, physician associations and, from April 2021, community paramedics. However, a range of new roles have been added to the scheme from this April. PCNs will now also be able to recruit:
- Pharmacy technicians
- Occupational therapists
- Health and wellbeing coaches
- Care co-ordinators.
From April 2021 mental health practitioners will also be added to the scheme.
A set, maximum reimbursable amount that PCNs can receive for each role has been set - at the midpoint of the appropriate Agenda for Change band. From April 2020 PCNs will receive a pot of funding, based on their weighted patient list, and they will be able to choose how to spend it on any of the above roles.
The ARRS has also been expanded in that the overall plan is to have 26,000 more staff working in general practice by 2023/24, the end of this five-year contract period. This is 6,000 more staff than originally planned.
As a result of all these changes, funding for the ARRS overall has increased significantly. A further £173m will be invested this year, which will increase to an additional £521m by 2023/24. The total funding for the scheme in 2020/21 will be £430m, rising to £1.4bn in 2023/24.
According to contract documents the average PCN will receive £344,000 this year for additional staff, rising to £1,130,000 in 2023/24.
Under the agreement, funding for any staff employed by a PCN will be guaranteed up to 2023/24. Beyond this period these staff will be treated as part of the core general practice cost base and considered in future GP contract.
The BMA said these changes would mean ‘PCNs can recruit fully, without worry about the theoretical risk of future employment liability and redundancy costs’.
What has happened to the PCN service specifications?
Before Christmas NHS England put out five draft service specifications that it wanted PCNs to deliver from April, covering enhanced health in care homes, structured medication reviews, anticipatory care, personalised care and early diagnosis of cancer.
Concerns were raised by GPs and other commentators that the work involved in these was 'impossible' and this was a main reason the BMA rejected NHS England's initial contract offer in January.
Under the new plans the Service specifications for personalised care and anticipatory care have been shelved until 2021. Updated specifications covering the other three areas are set to go ahead this year.
However, GPs will no longer be expected to carry out fortnightly care home visits. Other staff will be able to carry out visits, with a requirement for medical input to be ‘appropriate and consistent’ based on the PCN's judgement.
A new ‘care home premium’ will provide networks with £120 per care home bed per year, following concerns raised by GPs over huge variations in potential workload between areas. This comes into effect when the service goes live from 30 September 2020.
The reworked contract deal makes a further concession around the volume of structured medicine reviews (SMRs) required from PCNs, with a clarification that networks with lower clinical pharmacist capacity will be required to carry out fewer reviews.
The contract also makes clear that PCNs will not have any contractual responsibility for any failure by community providers to deliver their part of the service.
There will be metrics associated to the services and the network contract DES for 2020/21 will contain 'specific requirements to improve data quality' for these metrics and to ensure appropriate use of related clinical codes that will be introduced during the year.
Read more on the service specifications here:
- Enhanced health in care homes
- Structured medication review and medicine optimisation
- Supporting early cancer diagnosis
What is the Investment and Impact Fund?
A new Investment and Impact Fund (IIF) will be introduced from April this year, which will reward PCNs for delivering objectives set out in the long-term plan.
It will work in a similar way to the QOF - it will be a points-based system that will contain domains relating to preventing and tackling health inequalities; providing high quality care and creating a sustainable NHS. Each indicator will be allocated a certain numbers of points and each point worth a certain amount of money.
Eight indicators are included in 2020/21, relating to seasonal flu vaccination, health checks for people with a learning disability, social prescribing referrals and prescribing. The fund will be worth £40.5m in 2020/21, increasing to £150m in 2021/22, £225m in 2022/23 and £300m in 2023/24.
In 2021/22 at least £30m of the fund will reward better access. Any money earned from the fund will need to be spent on staff or services provided by the network.
Are there any other changes?
From April 2020 GMS and PMS arrangements will be amended to make it clear that onward sub-contracting of clinical matters relating to the network contract DES will be alloed. This will enable PCNs to sub-contract the delivery of a particular aspect of the network contract DES to another organisation.
What else do practices need to know if they are particpating in the network contract DES?
From April 2021 a new process of auto-enrolment will be introduced for existing practices and PCNs. Practices who are already signed up to the DES, will automatically be signed up again and there will be an annual one-month window in which they will be able to opt-out – and when other practices who are not currently participating can opt in.
This year CCGs will confirm with practices that they are continuing to participate in the network contract DES on the basis of existing PCNs. Practices will be able to opt out of the DES this year up until 31 May 2020. Sign up and opt out after this date will only be allowed in exceptional circumstances.
Under the network agreement for 2020/21, PCNs will also need to set out the details of the collaboration agreement it has reached with its community providers and community pharmacy, particularly where this is necessary to deliver the service specifications. From April 2021, mental health providers will also have to be part of the network agreement.
Read more on Medeconomics
- Introducing social prescribers to your team
- Making best use of your clinical pharmacist
- Overview of the GP contract for 2020/21
- QOF changes for 2020/21
- Changes to vaccination payments under the GP contract