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Incentive scheme to reward PCNs on waiting times, finds Costanza Pearce
The past month has brought good and bad news for PCNs. On the plus side, NHS England has announced the introduction of the controversial PCN anticipatory and personalised care services is to be deferred until next year.
The other two PCN services that had been due to start this month – tackling CVD diagnosis and prevention and health inequalities – will go ahead in a ‘reduced’ form (see box 1).
But alongside this came an announcement that PCNs’ funding will be dependent on meeting targets for the number of online consultations they conduct from this month, and for seeing patients within two weeks from 2022.
In new guidance published in late August, NHS England set out the Investment and Impact Fund (IIF) indicators that will reward PCNs for work completed in 2021/22 and 2022/23 (see box 2). It confirmed that despite the delayed introduction of services, the IIF will be worth £150m in 2021/22 and £225m for 2022/23 ‘as previously set out’ – equating to around £120,000 and £180,000 respectively for an average PCN.
But the indicators to achieve these payments are controversial. From this month, PCNs will be rewarded for achieving ‘continued delivery of online consultations’ – measured by the number of such consultations they carry out.
And from next year, they will be measured against a two-week wait appointment target. Justifying this target, NHS England said: ‘Long waits for routine general practice appointments… are a leading cause of dissatisfaction with primary care services and can result in the escalation of clinical needs.’ It said it will ‘guard against the creation of perverse incentives for practices to refuse to book appointments more than two weeks in advance’.
Other indicators include:
• The number of emergency admissions per 100 care home residents in 2022/23, to reward PCNs for ‘moderating’ this.
• ‘Follow-up’ of patients with one-off high blood pressure readings to ‘confirm or exclude’ hypertension in both years, as well as the resulting rate of hypertension diagnoses.
As part of the service specifications, PCNs have also been told they must ‘improve identification of those at risk of atrial fibrillation’ through ‘opportunistic pulse checks’ when checking blood pressure, from 1 April 2022.
Meanwhile, all PCN clinical staff must complete mandatory 30-minute online ‘refresher’ training on shared decision making, by 30 September 2022.
Preston GP and clinical director of Ribble Medical Group Dr Partha Ganguli says the IIF funding is welcome, but adds: ‘As usual we are given responsibility to improve patient care, but we don’t have the time resources or the authority to do so. There is the risk of us not being able to deliver any sustainable change and only undertake some minor alterations to fulfil the criteria outlined.’
He adds: ‘Some of the requirements are set really high and can be very difficult to achieve.’
CV disease prevention and diagnosis requirements
Tackling neighbourhood health inequalities
Source: NHS England, Primary Care Networks – Plans for 2021/22 and 2022/23 – New PCN service requirements.
Number of online consultations on or after 1 October 2021 per 1,000 registered patients
Mean number of patient contacts as part of weekly care home round on or after 1 October 2021 per care home resident
From 2022/23, standardised percentage of [patient] survey respondents indicating that it was ‘easy’ or ‘very easy’ for them to make an appointment, or seek care
From 2022/23, percentage of patients who had to wait two weeks or less for an appointment
Source: NHS England, Annex B – Investment and Impact Fund: 2021/22 and 2022/23