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GPs buried under trusts' workload dump

PCNs who achieve targets 'further' and 'faster' to receive extra funding

NHS England has unveiled new financial incentives for primary care networks (PCNs) who meet certain targets ahead of others.  

In a letter sent last week to stakeholders, NHS England revealed that networks who will complete the national service requirements 'further' and 'faster' will be offered additional funding.

From next year, all networks will have to begin to fulfill seven service specifications, which include areas such as enhanced health in care homes, supporting early cancer diagnosis and cardiovascular disease prevention and diagnosis.

Pulse learned earlier this year that networks in a 'good position to make progress during 2019/20' were set to receive up to £200,000 out of an earmarked funding envelope worth £3m. 

But following criticism, with GPs calling the programme 'elitist funding', NHS England later decided to 'formally' scrap the controversial plans.

Instead, it has offered potential financial incentives to all networks. 

The letter, sent by deputy director for PCNs primary care strategy and NHS contracts group Robert Kettell, said networks who deliver the seven national service requirements 'further' and 'faster' will receive extra funding.

Mr Kettell wrote: 'In addition to the service requirements, changes in 2020/21 will include the introduction of the Network Dashboard and the Impact and Investment Fund which will complement service requirements. The service specifications will set minimum requirements within the DES. The dashboard will include measures of success to allow PCNs to benchmark their performance and monitor their delivery of the five service specifications.

'The Impact and Investment Fund (IIF) is expected to provide additional funding to PCNs which go further and faster to deliver the national service specifications and provide an incentive for PCNs to reduce unwarranted demand on NHS services, including overprescribing and inappropriate A&E attendances.'

Under the new networks contract DES, PCNs will be responsible for the delivery of seven national service specifications, which include:

  • Structures medications review and optimisation;
  • Enhanced health in care homes;
  • Anticipatory care;
  • Personalised care;
  • Supporting early cancer diagnosis;
  • Cardiovascular disease prevention and diagnosis;
  • Tackling neighbourhood inequalities. 

Lancashire and Cumbria LMCs chief executive Peter Higgins said he is concerned over the number of expectations placed on PCNs.  

He said: 'I am concerned that expectations on PCNs grow each day. The contract agreement and, within it the additional roles reimbursement scheme, were meant to address the severe workforce shortages and under investment in primary care. The expectation is that PCNs will require additional roles to meet the requirements of the seven service specifications but practices have to find 30% of the funding themselves.'

He added: 'I had hoped that the IIF, albeit retrospective, would plug this funding gap, but it sounds like PCNs are expected to go above and beyond the requirements of the service specifications to get their hands on this money. It feels unrealistic and I worry it will put many practices and PCNs off. We need to nurture and develop PCNs and not demand too much in these early days.'

Dr Scot Richardson, a GP partner and PCN clinical director in Hull, said: 'The IIF provides primary care with resource to ensure they are able to contribute and assist with the delivery of the long-term plan and effectively make real benefits for patients and our workforce. Within our PCN we are excited by this opportunity and welcome the dashboard as one form of a measure for success.

'We, however, acknowledge that primary care is one part of the system and while we are committed to reducing unwarranted demand on NHS services this must be done collaboratively and the onus cannot purely on primary care to solve this.'

NHS England said the funding for the specifications will 'develop over the subsequent four years following further engagement and discussion.'

Mr Kettell said: 'NHS England is developing proposals for the first year of the operation of the IIF, ahead of formal contract discussions with GPC England.’

In June, NHS Clinical Commissioners told Pulse that some of its members 'are concerned' their core funding is not enough to deliver the £1.50 per patient as mandated in the five-year GP contract.

 This article was amended to state that networks will have to begin to fulfil the seven service specifications from next year

Readers' comments (9)

  • Extended hours des and extended access DES already underfunded to the tune of at least 50% of monies needed to pay flat rate medic time.The cluster fu@@ is doomed to fail with an ever decreasing workforce with NO goodwill.

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  • A non-recurrent lure to get us to jump over the cliff, faster. The DES does not contain anywhere near enough funding to deliver the seven specifications, and there isn’t any more coming. I wonder if this falls apart next year, or the year after?

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  • One needs to be careful about these targets. A lot of work and not really any extra take home pay. Worse one gets poorer with pay to work. I know I won't be going for it. Not worth the effort. The extra staff opens one up to a whole heap of legal problems. Just one tribunal and any possible extra earnings ends. When PCN goes (just a matter of time), how are we going to get rid of the extra staff?

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  • not very fair is it?, a pcn may struggle due to issues beyond its control, such as location, population make up, house prices, transport costs etc or over loaded with nursing care facilities or excess elderly populations but will penalised financially for not being pcn savvy. So those PCNs with healthy young populations with good transport links, good housing and schools and less poverty will do well and be able to attract staff but others will not and lose out on the resources they actually need. Overall the 7 point plan is unworkable as it is vastly underfunded and does not have the staff to run it in place. Plus you have to train staff in the first place so none of it will really get going for at least 12 months if not longer. adding targets will work for the few PCNs with financially minded leaders. It will decimate rural and seaside based areas though that are already struggling to recruit and where housing and transport costs are putting off new workers. Its a bad project from start to end and only result in driving more staff out of the NHS. With all things you need the basics to be in place with strong foundations to build up a service and it needs to be fair and equal. The last 10 years of underfunded have decimated the service. This should be sorted first. As for the 30% pay to be provided by practices for new staff - what idiot suggested that one? Like anyone has any spare cash? Some of these are social and public health issues and should be coming from them, not PCNs. As our local council has decided to slash its public health budget and dump all the work on primary care with no funding or training - as was totally predictable when it was changed - who is actually going to do the work? The ones left are really too busy to do any more.

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  • usual bs from politicians

    privatize the nhs to get rid of politicians and unions--it will never improve otherwise

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  • 'Tackling neighbourhood inequalities' ; would love to know how they plan on fairly measuring the attainment of this target...!

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  • Is there any detail about

    1) The required specification of the above services?
    2) The level of extra funding for the above?

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  • Vinci Ho

    https://www.healthylondon.org/wp-content/uploads/2017/10/PCN_Development_Support_Prospectus_FINAL_London.pdf

    Read this if you want

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  • Started reading- made me vomit- so glad to have retired.
    Nurses nursing and doctors doctoring seems utterly irrelevant to these managers coming up with wonderful utterly impractical and non-costed, non-funded initiatives which are designed to leech money away from all patient-doctor interfaces by huge time draining distracting, eminently unworkable sound-bite initiatives.
    A bit like- prescribe the latest bestest drugs, then get blamed for polypharmacy, CCG MMT's step in to reduce prescribing of stuff which we were actually tricked into prescribing in the first place.....could go on!!!

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