Explained: All the changes to the PCN incentive scheme

Pulse explains everything you need to know about the changes to the PCN incentive scheme

NHS England announced last week that it would immediately retire or defer until next year four investment and impact fund (IIF) indicators worth £37m and reallocate this funding to PCNs via a monthly support payment. 

But lots of the details remained unclear. Here is everything Pulse has learned about the changes.

Which indicators have been scrapped or deferred?

Deferred:

• ACC-02: Number of online consultation submissions received by the PCN per registered patient. This indicator started on 1 April and is worth 18 points.
• EHCH-06: Standardised number of emergency admissions on or after 1 October per care home resident aged >= 18. This indicator was due to start on 1 October and is worth 27 points.
• ACC-08: Percentage of patients whose time from booking to appointment was two weeks or less. This indicator started on 1 April and is worth 71 points.

Retired:

• ACC-05: By 31 March 2023, make use of GP Patient Survey results for practices in the PCN to (i) identify patient groups experiencing inequalities in their experience of access to general practice, and (ii) develop, publish and implement a plan to improve patient experience and access for these patient groups, taking into account demographic information including levels of deprivation. This indicator started on 1 April and is worth 48 points.

When will the deferred indicators resume?

The three deferred indicators – covering two-week waits, online consultations and emergency admissions – will resume in April 2023.

Does the £37m that will be reallocated to PCNs represent the total available if all PCNs achieved the top targets in the four deferred/retired indicators?

No, the £37m is the amount that would be paid out to PCNs if 90% of the available points were earned nationally against all four indicators. NHS England said this is in line with how the IIF is valued across indicators.

How much could an individual PCN earn from this?

The four indicators are worth a combined 164 points, which at £200 per point (adjusted for list size and prevalence) for this year comes to a total of £32,800. This is the maximum payment that a PCN with the average adjusted population size could earn against the four deferred/retired indicators.

Will each PCN receive the same amount of money each month via the new support payment?

The monthly payment will be based on each individual PCNs’ adjusted population. But each PCN will receive its share in six equal monthly instalments, starting this month and running until March.

Can PCNs decide how they will spend this money?

NHS England has said that the support payment ‘must be used to purchase additional workforce and increase clinical capacity to support additional appointments and access for patients’. It said this is ‘in line with the reinvestment commitment relating to IIF earnings’.

How will PCN spending of the funding be monitored?

NHS England guidance said PCNs must ‘commit in writing’ to the commissioner that they will reinvest any support payments into additional workforce and increased clinical capacity to support additional appointments and access for patients, as above.

What payments have PCNs already received for work completed against these four deferred/scrapped indicators?

PCNs haven’t received any payments yet for work already completed against the indicators because performance is assessed at the end of the financial year.

What other changes have been made to the IIF?

NHS England has amended the thresholds for two indicators to better reflect how they are carried out:

• The threshold for CVD-02, which relates to the percentage of patients on the QOF Hypertension Register, has been reduced from a 0.6/1.2 percentage point increase to 0.4/0.8.
• The threshold for PC-01, which relates to the percentage of patients referred to a social prescribing service, has been lowered from 1.2%/1.6% to 0.8%/1.2%.

It has also amended the wording for two indicators to make them ‘easier to achieve’:

• CAN-01, which recognises PCNs for ensuring that lower gastrointestinal fast-track referrals for suspected cancer are accompanied by a FIT, will change the permissible time between FIT result and referral from seven to 21 days.
• And CVD-04 – which recognises PCNs for referring patients with high cholesterol for assessment for familial hypercholesterolaemia – will have its list of success criteria expanded to include diagnoses of secondary hypercholesterolaemia, genetic diagnoses of familial hypercholesterolaemia, and assessments for familial hypercholesterolaemia, in addition to referral for assessment for familial hypercholesterolaemia.

Were there any other measures?

The changes to the PCN incentive scheme targets came as part of a set of measures designed to relieve practice workload over the winter.

Alongside the changes to the IIF, NHS England also announced changes to the additional roles scheme and scrapped the controversial shared decision-making training for all PCN clinical staff.

It also asked integrated care boards (ICBs) to identify where to allocate potential additional winter support funding to GP practices and PCNs in their area, if such funding were to materialise, with a focus on areas with deprivation and recruitment challenges.

And it suggested that responsibility for the network DES anticipatory care service will be shifted to integrated care systems (ICSs) to ‘better reflect system-level work’, from April 2023. PCNs are now expected to ‘contribute to ICS-led conversations’ on the implementation and delivery of the anticipatory care service which will be designed and planned by the ICSs.