On 23 August, NHS England (NHSE) published a letter outlining plans for primary care networks (PCNs) in 2021/22 and 2022/23. Recognising the pressures currently faced by general practice, the letter confirmed a gradual introduction of new PCN service requirements, with most of the focus on implementation in 2022/23 to allow PCNs time to plan and do preparatory work.
These PCN service requirements will support five areas of focus to improve delivery of primary care. PCNs will be able to access significant funding for the activities through the Investment and Impact Fund (IIF), and NHSE also promised new funding to support PCN leadership and management.
Areas of focus for PCNs
In its letter, NHSE announced five areas of focus for PCNs over the next 18 months, which were identified in consultation with representatives of GPs, practice staff, and patients. These are the key objectives that align with priorities for general practice, long-term plans and the NHS response to COVID-19:
- Improving prevention and tackling health inequalities in the delivery of primary care. PCNs will need to identify and support high-need local populations, and address inequalities in diagnosis rates for cardiovascular disease (CVD) and cancer.
- Supporting better patient outcomes in the community through proactive primary care. This will include delivery of the Enhanced Health in Care Homes and Anticipatory Care services, with multidisciplinary teams offering more personalised services to help avoid unnecessary hospital admissions.
- Supporting improved patient access to primary care services. This will include a PCN-based approach to extended access provision, and rewarding PCNs that improve the patient experience, avoid long waits for routine appointments and tackle the backlog of care.
- Delivering better outcomes for patients on medication. PCNs will need to deliver Structured Medication Reviews to priority patient cohorts, and target prescribing behaviours known to improve patient safety.
- Helping create a more sustainable NHS. This will be done by reducing the carbon emissions generated by asthma inhalers.
New PCN service requirements will be phased in gradually
New PCN service requirements will support the five areas of focus, but in light of workload concerns in general practice, they will be phased in gradually, with some specifications delayed until 2022/23 and others introduced in a reduced or preparatory form in 2021/22.
The letter summarised the requirements to be introduced:
- CVD prevention and diagnosis
- From October 2021: Focus on improving hypertension case finding and diagnosis.
- From April 2022: Increase diagnosis of atrial fibrillation, familial hypercholesteremia and heart failure.
- Tackling neighbourhood health inequalities
- From October 2021: Identify and engage a local population experiencing health inequality; co-design an intervention to address the unmet needs of that population.
- From March 2022: Delivery of the co-designed intervention.
- Anticipatory Care
- By 30 September 2022: Agree a plan for delivery of the Anticipatory Care service with their Integrated Care System and local partners.
- Personalised care
- From April 2022: Focus on 1) further expansion of social prescribing to a locally-defined cohort unable or unlikely to access it through established routes, 2) supporting digitised care and support planning for care home residents, 3) training on shared decision making.
From 1 October 2021, practices have been auto-enrolled (if there are no changes to their PCN details) into the revised Network Contract Directed Enhanced Service (DES) for 2021/22, which incorporates these changes. Practices have one calendar month to opt out if they wish to.
The changes for 2022/23 will appear in the 2022/23 Network Contract DES. Furthermore, from April 2022, PCNs will deliver a single, combined extended access offer funded through the Network Contract DES. Details are expected to be published this autumn.
Funding incentives to support PCN areas of focus
Significant funding is set to be available to PCNs to support their activities in meeting the service requirements. PCNs will be rewarded financially for meeting performance indicators, as detailed in the IIF Indicators for 2021/22 and 2022/23. These are aligned with the areas of focus.
Through the scheme, £150m will be available for 2021/22, rising to £225 for 2022/23. PCN Clinical Directors will have responsibility for ensuring that use of the IIF is re-invested wherever possible in services and staff, such as extra GPs and practice nurses.
To maximise the impact of the PCN services, NHSE also announced new funding of £43m to support PCN leadership and management in 2021/22. Allocation will be adjusted for unmet need in areas of higher deprivation. PCN Clinical Directors will be responsible for recommending how this funding is used.
PCN Network Chair, Dr Pramit Patel, said: “The introduction of dedicated funding for management resource is long overdue and will enable PCNs to put in place a more robust management infrastructure necessary to oversee the increasing amount of responsibility they are being given”.
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