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Primary care networks must cover patients from practices that remain solo

All patients will need to be covered by a primary care network, even if not all practices join them, according to the new GP contract.

The new five-year deal, published yesterday, aims to get 100% geographical coverage of primary care networks from 1 July this year.

Practices joining the networks, which will cover 30,000 to 50,000 patients and be led by a local GP in a clinical director role, will receive an average uplift of £14,000 through a new DES.

The BMA has now clarified the new contract means every patient must be covered by a network - including those from practices which decide not to join.

The networks will be based on geography, and will require practices to choose a lead and implement governance processes to qualify for the funding from July.

In following years, seven 'service specifications' will be gradually implemented as part of the DES based on the clinical strategies set out in the NHS long-term plan, including increased screening and earlier detection of cancer.

According to the new contract, the ‘success’ of the networks will ‘depend on the strength of its relationships, and in particular the bonds of affiliation between its members and the wider health and social care community’.

‘The main reason NHS England and GP Committee England are backing primary care networks now is because they have emerged from a practice-led process.’

As of October last year, 88% of practices were already part of a network.

But the contract said an ‘entirely bottom-up primary care network formation may not generate a solution that works for absolutely every practice, right across the country’.

‘In some CCGs, marginal adjustment to primary care network membership and boundaries may prove necessary,’ it said.

Adding: ‘We cannot leave a small number of practices and their patients behind, excluded from joining a primary care network and the benefits of investment and new services’.

As such, CCGs in collaboration with LMCs ‘must ensure all practice lists are covered’ by a network in their area, for the provision of network services.

However, if a practice does not wish to join to the network contract DES – a situation the contract describes as ‘highly unlikely’ - it will not have to, although its patient list will still need to be covered by a network.

‘That network then takes on the responsibility of the network contract DES for the patients of the non-participating practice through a locally commissioned agreement. For those patients, it receives all the network financial entitlements, and it delivers the network service specifications as well as supplementary network services,’ the contract explained.

However, GPC England and NHS England will ‘work together’ to support LMCs and CCGs in resolving ‘difficult issues’.

Commenting on whether current networks will need to change under the new contract, GP Committee chair Dr Richard Vautrey said: ‘The intent is to try and build on networks that already exist, but make sure there are no gaps. So, a CCG and the LMC working together should try to ensure all patients within an area are in a network.

‘This is something the local rea need to work on in a sensible and pragmatic way.’

When asked about networks that go over a CCG boundary, he said: ‘Where the geography makes sense and the local population makes sense, then current networks should be something that we build on. But if there are reasons to make changes that that is something that the CCG and LMC can help them on.

‘This should be led by the practices, there just cannot be gaps between them and their neighbouring network. They will need to recognise that the networks have to be geographically contiguous.’

All the headlines from the 2019/20 GP contract at a glance

Timetable for network contract DES introduction

January to April 2019: Primary care networks prepare to meet the Network Contract DES registration requirements

By 29 Mar 2019: NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network Contract DES

By 15 May 2019: All primary care networks submit registration information to their CCG

By 31 May 2019: CCGs confirm network coverage and approve variation to GMS, PMS and APMS contracts

Early Jun: NHS England and GPC England jointly work with CCGs and LMCs to resolve any issues

1 Jul 2019: Network Contract DES goes live across 100% of the country

Jul 2019-Mar 2020: National entitlements under the 2019/20 Network Contract start:

  • year 1 of the additional workforce reimbursement scheme
  • ongoing support funding for the clinical director
  • ongoing £1.50/head from CCG allocations

Apr 2020 onwards: National Network Services start under the 2020/21 Network Contract DES

Source: A five-year framework for GP contract reform to implement The NHS Long Term Plan

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Readers' comments (4)

  • Suppose reading through this is a way of devolving the closing practice conundrum, instead of being an issue for the executive it becomes an issue for the network(GPs),good luck with that as we get more practices closing over the next five years(not small ones either).

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  • Responsibility for extended hours provision for the practices not engaged. That is certainly a reason to not engage.

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  • If it is to work we need to be allowed to focus on productive work. And it will be hard, given all the reforms, workload and workforce issues already on our plate. Any distraction, adjustment, new 'initiative', additional requirement and each change will waste energy and damage trust.

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  • There are ideas, we all have some, that would be constructive. And for each there are ways of sabotaging them. e.g. MDT: In-house small MDTs can be focussed and productive. MDTs for 50,000 town populations tend to be a monumental waste of time!

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