What next for primary care networks? Changes to the Network Contract DES in 2024/25

Written by Samuel Trevena, manager in the medical sector team

Introduction

With the Network Contract DES five-year commitment coming to an end in March 2024, there has been uncertainty in recent years regarding the future of primary care networks (PCNs).

In an open letter from NHS England, the key areas of focus for the 2024-25 year (and perhaps beyond) are:

• To reduce bureaucracy for practices – through protecting 32 out of 76 of the Quality and Outcomes Framework (QOF) indicators as well as reducing the number of the Investment and Impact (IIF) indicators from five to two
• To help practices with cash flow – the Capacity and Access Improvement Payment (CAIP) will now start to be paid once PCNs confirm they meet the simple criteria for payment
• Providing PCNs with greater staffing flexibility – by widening the number of reimbursable roles and removing restrictions where possible
• Supporting practices and PCNs to improve outcomes by simplifying the DES requirements.
• Improving patient experience of access

While the announcement, extending the current contract until 31 March 2025, doesn’t answer all of the questions, it does provide an indication of the future landscape for PCNs.

Headline changes

Overall contract investment will increase by £259m in 2024-25, of which £215m is for the core contract and a further £44m for the PCN DES.

Reducing the cash-flow burden on practices

• The CAP funding will increase by £46m to £292m, by retiring three IIF indicators. 70% of the funding will continue to be paid to PCNs without any conditions, proportionate to their adjusted population in 12 equal payments
• The remaining 30% will be paid to PCNs via CAIP and may be paid to PCNs at any point in the year in monthly instalments once certain criteria have been met

Improving staff flexibility for PCNs

In an attempt to alleviate the rising demands on GPs, there are a number of changes to the Additional Roles Reimbursement Scheme (ARRS) to increase the scheme’s flexibility.

• Enhanced practice nurses will now be included in the roles eligible for reimbursement (capped at one role per PCN, or two with PCN list sizes greater than 100,000)
• Where PCNs are already supported by one mental health practitioner (MHP), which is currently 50:50 funded by the PCN and the mental health provider, PCNs may now be reimbursed up to 100% through the ARRS for additional MHPs
• Caps on all other direct patient care roles will be removed
• PCNs will now be able to claim reimbursement for the time personalised care roles undertake in training or apprenticeships

The BMA’s GP committee has been rallying for GPs to be included as a role reimbursable under ARRS, although this was met by resistance from NHS England and the Government, and there remains no provision for this within the 2024-25 contract. Similarly, whilst the ARRS funding allows for the reimbursement of enhanced practice nurses, this rules out a significant number of nurses who do not meet the criteria.

While there has been expansion to the number of roles reimbursable under ARRS, it begs the question whether the GP role is becoming less attractive in what is already a difficult climate. 

Streamlining the PCN DES requirements and increasing autonomy

• PCN clinical director and PCN leadership and management funding will be rolled into core PCN funding

Use of a company and recruitment decisions

As the PCN contract and landscape has evolved over the past five years, many PCNs have considered, and opted to use a company (often referred to as incorporating your PCN) to isolate the PCNs activity. Commonly, companies are set-up to employ PCN staff, with their salaries then reimbursed by the member practices using ARRS funding. However, it is also possible to subcontract the whole PCN DES requirements to the PCN company, although this is typically more complex as it requires the PCN company to provide clinical services, and thus a CQC registration is needed.

Despite the benefits of using a company, many PCNs have taken the pragmatic approach recently to delay any decision until further clarity surrounding the contract has been provided, given the financial and administrative burden involved. Unfortunately, the current extension has not necessarily provided the answers many PCNs have been waiting for.

Similarly, while there have been funding increases and improved flexibility through ARRS, PCNs – both unincorporated and incorporated – may be concerned about the implications of recruiting additional roles beyond 2024-25, without a lack of clarity around what any future contract may look like.

PCNs here to stay?

General practice is without doubt experiencing a difficult time of late, and with costs continuing to rise, it was hoped that practices might see additional investment to off-set the on-going inflationary pressures that are being felt. Staff costs continue to soar and there is no doubt concern whether the recent contract changes provide sufficient investment for practices to continue.

However, despite the concerns of the lack of clarity beyond 2024-25, PCNs remain a core component of the NHS long term plan. NHS England has expressed time after time that its view is that the size of typical PCNs strike the right balance between offering the best provisions of care, in terms of access and range of services whilst recognising and keeping the quality of care delivered to the local community.

In discussions with our contacts through the AISMA network, it is also becoming more common for PCN companies to bid for primary care contracts in their own name. If this trend continues, we feel it is likely that collaboration between PCNs will increase, in order to provide services at an even greater scale.

How we can help

At PKF Francis Clark, our specialist medical department acts for a significant number of primary care networks, both unincorporated and incorporated (using a company).

Please contact your local expert with any questions you may have and we will be more than happy to help you.