Have you joined a Primary Care Network (PCN) yet?

A requirement of the new GP contract means that practices will need to join a Primary Care Network (PCN). It is hoped that PCNs will help GP partnerships to survive and evolve over the coming decade.

PCNs are groups of practices working together covering patient populations of 30,000 to 50,000. A range of healthcare professionals will provide PCN services and they will be funded by CCGs. A super partnership can act as a single PCN even if the population is more than 50,000.

All practices will need to be signed up to a PCN by 1^st July 2019. Practices will receive a Network Participation DES, which is £1.76 per patient. This is a practice payment and it will be up to practices to decide how this will be spent.

Funding for PCNs

The funding for PCNs will be from a large directed enhanced service. There are several different funding streams which are as follows: -

• Network Payment – PCNs will receive a recurrent payment of £1.50 per patient, per annum.

• Extended Hours DES – This will transfer from practices to the PCNs from 1^st July 2019. This is £1.45 per patient. An average PCN with 50,000 patients will need to provide 25 hours extended access per week, shared between mornings, evenings and weekends.

• Extended Access Funding – The £6 per patient that is currently provided for the extended access scheme will eventually be transferred to the PCNs. The timing of this transfer will depend on the CCGs but this funding should be transferred to PCNs by 2021.

• Clinical Director – Every PCN will need to appoint a clinical director, the funding available is for a 0.25 FTE clinical director and it amounts to 68.7p per patient. So, a PCN with 50,000 patients will receive funding of £34,379.

Additional Role Reimbursement Scheme

There will be £891m investment over 5 years to develop PCN workforces covering clinical pharmacists, social prescribers, physician associates and first contact physio.

The reimbursement of these roles will be 70% for clinical pharmacists, physician associates and first contact physio. The 30% will be a cost to the PCNs and this will need to be funded by the practices.

There will be 100% reimbursement of social prescribers.

The reimbursement is to cover the total cost of employing these roles including employer’s national insurance and employer’s pension contributions.

For 2019/20, the funding available is 70% reimbursement for one whole time equivalent pharmacist and 100% reimbursement for one whole time equivalent social prescriber. For PCNs with 50,000 patients this will amount to £37,810 (70% of £54,000) for a pharmacist and £34,110 for a social prescriber. The funding for the pharmacist and social prescriber is the same if your PCN has 30,000 patients or 50,000 patients.

Example of Funding Available for a PCN

Practices will need to fund 30% of the pharmacist which in 2019/20 would be £16,910. The funding practices are receiving for the network participation DES could be used to fund this shortfall.

Structures of PCN’s

It will be up to individual PCNs to decide what structure they will set up, the types of models that can be used are: -

• Flat Practice Model – One practice of the PCN will be nominated as the payee to receive the money. The costs will be shared between the practices. The PCN workforce would be employed under shared employment contracts so there would be no VAT issues and income can be pensioned.

• Lead Practice Model – one practice of the PCN will take responsibility for the PCN organization and will receive the funding and pay out all costs. Tower Hamlets have been using networks for many years and this is a similar structure that many of their networks used. Potential VAT issues with this model if one practices supplies staff to other practices.

• GP Federation/Provider Entity Model – a separate entity such as a limited company would be used as the PCN and practices can be shareholders of the company (although a practice cannot hold shares, but a partner would on behalf of the practice). However, with this model there could be issues with VAT as the separate entity would be supplying staff to the practices which is a Vatable supply. Also, the entity would not have automatic right to the NHS Pension scheme.

It is advisable that if a PCN uses a flat structure or lead practice model that a separate bank account is set up for the PCN and accounts are prepared for transparency, even though there is no legal requirement. A separate entity such as a limited company will require accounts to be prepared each year and submitted to Companies House.