ICBs receive powers to vary PCN contracts locally to develop neighbourhood services

ICBs will be allowed ‘greater flexibility’ to tailor contract arrangements for PCNs to facilitate the creation of neighbourhood services, NHS England has revealed.

In a variation to the Network Contract Directed Enhanced Service (DES) specification for this financial year, the commissioner said that the DES has been updated to enable ICBs to ‘request local variations’.

Experts have told Pulse that this introduces the ability for ICBs to vary the PCN DES at a local level with the approval of NHS England, and could potentially ‘kill the possibility of single neighbourhood provider contracts’, which were announced as part of the 10-year plan.

NHS England said that ‘local variations agreements’ introduced as part of the change are intended to allow ‘approved variation of limited parts’ of the DES specification.

In an explanatory note, NHS England said: ‘This allows greater flexibility to tailor arrangements to local circumstances where existing local contractual routes may not be sufficient.

‘The changes could support ICBs that are developing neighbourhood services by using the Network Contract DES framework.

‘These amendments are separate from the proposed Multi Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) Contracts, which will be subject to a separate DHSC and NHS England consultation.’

When submitting a request for variation, ICBs should ‘provide sufficient detail’ to enable NHS England to understand the ‘proposed model and its intended effect’, the documents added.

This should include the rationale and ‘expected benefits’ of the proposal, any patient cohort or population to which it is directed, the role of each participating practice, any shared delivery model or operational integration across practices, and any relevant partnership working with other providers or stakeholders.

Medical accountant Andy Pow told Pulse that this was a big change for PCNs ‘dressed up as something quite vague’, and that it could mean PCNs will be the vehicle to implement neighbourhood services.

He said that the new powers could be used differently depending on the area, adding that ‘pro GP’ ICBs could use it advantageously for practices, but that ‘anti GP’ ICBs could use it to ‘take away control’.

Mr Pow said: ‘It could be killing off the possibility of single neighbourhood provider contracts, because why would you need an SNP contract if you can change anything you want thought the actual existing DES that you’ve got.

‘Which could be positive, because actually creating another tier of contracts could be another nightmare to deal with.

‘But this could mean that PCNs are being moved from a mechanism to employ staff across practices, to being the model through which they [NHS England] are possibly going to try and change general practice provision – so it’s changing the whole concept of what a PCN is.

‘To be honest, I don’t know whether it’s going to be good or bad – it will very much depend on the area.

‘Whether that is a good or bad thing, we just don’t know yet. I can see it working, but I can also be a disaster. It is arguably the biggest shift in resourcing that we have seen since the PCN DES came in.’

BBO LMCs chief executive Dr Matt Mayer told Pulse: ‘These amendments to the PCN DES are very alarming. It appears now that rather than having a nationally negotiated DES, we are transitioning to a “PCN LES” where systems will be able to impose changes to funding, targets, requirements, and access, upon PCNs and their member practices seemingly with no requirement for scrutiny by LMCs.

‘These changes have come completely out of left field and will cause enormous uncertainty and concern for practices. We need urgent answers as to what involvement the BMA had in these changes, and what steps they are taking to oppose and resist them.’

Katie Collin, partner at specialist medical accountancy firm Ramsay Brown, told Pulse that it looks as though ICBs will have a ‘pick and mix’ option open to them, allowing them to ‘add and remove different services to and from the DES’.

She added that the changes mean that funding can ‘more easily shift’ into areas that need it, but that the biggest concern is that this will give ICBs the power to ‘take practice income out and into PCNs and neighbourhoods’.

She said: ‘I suspect this is all about getting PCNs to start delivering neighbourhood services without having to issue new standard contracts, in line with the 10-year plan.

‘The trouble is that this sends a worrying signal that practices and PCNs will have less financial security over the long run.

‘Practices must have a voice in deciding which services are needed at a local level, and they need clarity over just how secure DES funding will be. That mustn’t fall by the wayside during this neighbourhood health push.’

Last month NHS England said that the new neighbourhood contract models will be developed in this financial year.

NHSE said that 2026/27 will be ‘a developmental year’ for the new contractual models despite the contracts initially being expected at the end of last year.

The Government recently confirmed as part of a new framework that NHS trusts will have commissioning responsibilities for primary care, through new integrated neighbourhood organisation (IHOs) contracts.