Practices in England will only have six weeks to form their networks, from when the full requirements are released to the mid-May registration deadline.
The BMA has released guidance on how the groups – to cover 30,000 to 50,000 patients – will operate and what practices can expect in the next six weeks.
CCG pressure
The understanding is that GPs should lead the formation of networks. However, BMA GP Committee executive team member Dr Farah Jameel told Pulse the BMA had heard of ‘CCGs telling primary care networks who their clinical directors should be, and what their geography and boundaries should be in order to align with local community teams’.
The BMA’s primary care network handbook1 states ‘the geographic coverage of the primary care network (PCN) is up to the member practices to decide… The only involvement of the CCG in this process should be when there are gaps in the total PCN coverage of their area’.
The handbook also clearly states the network agreement – outlining network operation and services provided – ‘is not within the remit of the CCG to challenge’.
We’ve heard of CCGs telling networks who their clinical directors should be – Dr Farah Jameel
Funding
Each network will need to nominate a practice to receive the new ‘Network DES’ funding on its behalf. This will comprise a flat fee for new staff, a transfer of the extended access funding, a payment of 59p per patient to cover leadership of the network and an additional £1.50 per patient through ringfenced CCG funding.
Pulse’s analysis of the BMA’s guidance shows networks of 30,000 patients will receive 97p per patient more than those of 50,000 – because in the first year networks will largely receive a flat fee for new staff regardless of size (see table).
Pulse has also learned that under the new DES, funding for extended hours will be reduced – with networks paid £1.45 per patient, 45p less than practices now receive for the extended hours DES. The total funding pot will remain the same, but from July, 100% of patients have to be covered for GPs to receive the funding, as opposed to the current 75.7%.
The BMA and NHS England point out that £30m has been added to the global sum – which rises by 92p per patient – to cover this extra work and the stipulation for NHS 111 to directly book appointments.
Different structures
The BMA handbook explains networks can be structured in a number of ways, citing five possible models:
• A flat practice network, with responsibilities and funding spread between members.
• A lead provider, where a single practice is the focal point.
• A GP federation/provider entity, subcontracted to deliver services.
• Existing superpractices, which may need to form mini-networks due to their size.
• A non-GP provider employer model, in which practices ally themselves with another local healthcare provider.
Governance
The guidance suggests a clinical director – not necessarily a GP – can be selected through a normal appointment process, such as a selection panel. Alternatively, practices could do this by election, potentially overseen by the LMC.
Practices are advised to set out a clear decision-making process for the network. This should identify all those acting on behalf of network members – for example, one representative from each practice, a selection of individuals from across the network or all partners from each practice – and establish the weighting of votes.
HR issues
The BMA says networks need to consider how the influx of non-GP staff will affect their employment liabilities, such as any future redundancies. Practices could consider limited liability structures, or sharing liabilities across the network.
Healthcare staff hired by the network may have problems accessing the NHS pension scheme, depending on the network structure, the guidance suggests.
To have access to the scheme, the employing body must hold an NHS contract. If a network is set up under a limited liability structure, such as a GP federation, the new staff employed may not be able to access the scheme.
This is ‘under discussion with NHS England’, and the BMA hopes for a resolution ‘in the near future’. But changes are unlikely to be ready by July, when networks are due to be up and running.
Reference
1 BMA. The primary care network handbook. London: BMA, 2019.
