1. NHS Long Term Plan, New GP Contract & Partnership Review
Opportunity or Diversion

2. THE STATE OF GENERAL PRACTICE

3. THE KEY RISKS RISK Loss of Income GPs leaving prematurely
Stress & Burnout
Premises – Last Man Standing
Practice Failure
Indemnity
Collapse of the Partnership Model
Unlimited Personal Financial Liability

4. How will these national initiatives address your personal situation, your practice and your health community?
Are they an opportunity to make things better
What challenges to they bring?
What is the starting position in your ICP and where does it need to get to?

5. THE NHS LONG TERM PLAN Five Major Changes to the Model of NHS Care
To boost out of hospital care and dissolve the historic divide between primary and community care
Redesign and reduce the pressure of hospital emergency care
People will get more control over their own health and their personalised care when they need it
Digitally enabled primary care and outpatients
Local NHS organisations will have greater focus on population based and health partnerships with local authority funded services through integrated healthcare systems everywhere in England.

6. Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan
Consolidation and implementation of recommendations of the Partnership Review and NHS Long Term Plan

7. Workforce – The Top Priority
5000 Extra Doctors still promised
Extended Programmes to 23/24
International recruitment
Retained doctors (from retiring)
GP retention programme (retain rather than reduce)
Resilience programme
GP Health
Time for Care Programme

8. Workforce 2
Increased numbers of primary care nurses – guaranteed placements for undergraduate nurses, increase in apprenticeships, ANP credentialling, retention scheme
Two year primary care fellowship programme for newly qualified doctors and nurses
Primary Care Training Hubs from 20/21
Major expansion of Community Mental Health Workers – aligned to PCNs
Consideration of Partial Pension Option
Expansion of the MDT through additional roles reimbursement

9. Workforce 3
5 Roles created to be an integral part of core general practice
Clinical reimbursement 19/20
Social prescribing Link reimbursement 19/20
Physician 70% 20/21
First Contact 20/21
First Contact Community 21/22
One of each per network in 19/20
Up to 20,000 new staff by 2024 on a network capitation basis

10. Workload – Not addressed directly, but:
Increased workforce to relieve pressure
PCNs to provide more integrated wrap around
Digital solutions
Eventual integration and control of urgent primary care services

11. Resources Direct to Practice
Global sum uplift by 1% (£0.92 per patient)
£20m into global sum for SARs
£30m into global sum for NHS 111 Direct Booking
Weighted SFE Payment of £1.76 to each practice for network participation
Relief of Indemnity Costs
£5 per patient MMR catch up
Vacc & Imm increased to £10.06
Taken together this will deliver a 2% pay uplift for GPs and practice staff

12. Resources Paid in Year 1 to PCN Bank Account
£1.50 per patient Network DES
£1.45 per patient extended hours funding
0.2 wte Clinical Director
£34,113 Social Prescriber
£37,810 Clinical Pharmacist
For a Network of 40,000 population this amounts to £203,000, of which £103,500 is for network decision

13. Growth in Additional Role Reimbursement Funding
INTENDED FUNDING FOR ADDITIONAL ROLE REIMBURSEMENT
19-20
20-21
21-22
22-23
23-24
National Total (£m)
£110
£257
£415
£634
£891
Average maximum per 50k typical network (£000)
£92
£213
£342
£519
£726

14. Investment and Impact Fund
Against performance on PCN Dashboard, the 7 service specifications and their impact on hospital usage
20/21
£75m
21/22
£150m
22/23
£225m
23/24
£300m
£54,545
£109,091
£163,636
£218182
Potential Income for a 40,000 PCN

15. Integrating Extended Access, Extended Hours and Urgent Care
Extended Hours payable at £1.45 per head immediately
Extended per head payable from 21/22
Payable on implementation of the Access Review

16. Addressing the weaknesses in QOF
Seen as tick box medicine
Exception Reporting Crude
Adapting to the Changing evidence base
Link to NHS Long Term Plan Priorities
Retiring 175 points (31%)
Recycling 101 into more clinically appropriate areas
Remaining 74 points recycled into 2 Quality Improvement Modules
Personalised Care Adjustment

17. IT & Digital Requirements
From April 2019 practices will be required to:
Provide new patients with full online access to prospective data from their patient record (using/referring to national NHS Login identity verification)
Reserve appointments for NHS 111 clinicians (not lay call handlers) to book patients into. This will be 1 appointment per day, per 3,000 patients (rounded down, with a minimum of 1), eg:
1500 patients = 1 appointment
5900 patients = 1 appointment
6001 patients = 2 appointments
These should be spread evenly through the day and the practice can decide how to manage patients booked into these appointments
These appointments may be freed for others to book if not booked.

18. IT & Digital 2 During 2019, practices will need to prepare to:
provide all patients with online access to their full record including the ability to add their own information from April 2020
make at least 25% of all appointments available for online booking by July 2019
offer online consultations by April 2020, subject to further guidance
offer and promote electronic ordering of repeat prescriptions for all patients for whom it is clinically appropriate by April 2020
all patients to be able to access online correspondence by April 2020
no longer use fax machines for NHS work or patient correspondence by April 2020
ensure they have an up-to-date and informative online presence by April 2020

19. What is a Primary Care Network?
A working definition
Primary care networks enable the provision of proactive, accessible, coordinated and more integrated primary and community care improving outcomes for patients. They are likely to be formed around natural communities based on GP registered lists, often serving populations of around 30,000 to 50,000. Networks will be small enough to still provide the personal care valued by both patients and GPs, but large enough to have impact through deeper collaboration between practices and others in the local health (community and primary care) and social care system. They will provide a platform for providers of care being sustainable into the longer term.

20. Where are we going – Primary Care Services?
MDT in PCN
embedded in general practice
Social Prescribing
Minor injury service
Social Care
Care navigation
GP led
Primary Care
Sign posting
District Nurses
Therapist
Care of the elderly
New services
based in PCN
Consider
Self Care
New capacity based in PCNs
MSK
Diabetes
Dermatology
nhs.uk
Apps and wearables
Clinical
Pharmacist
Advanced Nurse
Practitioner
CVS
Paramedic
MSK
Practitioner
Patient Activation
for LTCS
111 Online and 111 Hubs
Physician Associate
Mental Health Therapist

21. The Ask of PCNs
A number of network services will be developed in line with NHS England’s Long Term Plan, and phased into the DES over the coming years.
2019
Extended Hours access integrated into networks – same requirements as the DES, for 100% of network population
2020
Structured medication review
Enhanced health in care homes
Anticipatory care (with community services)
Personalised care
Supporting early cancer diagnosis
2021
Cardiovascular disease prevention and diagnosis, through case finding
Action to tackle inequalities
The content, and associated service specifications for these, will be subject to annual negotiation with GPC England

22. A mature PCN
Fully interoperable IT, workforce and estates across networks, with sharing between networks as needed.
Systematic population health analysis allowing PCNs to understand in depth their populations’ needs and design interventions to meet them, acting as early as possible to keep people well.
Fully integrated teams throughout the system, comprising the appropriate clinical and non-clinical skill mix. MDT working is high functioning and supported by technology. The MDT holds a single view of the patient. Care plans and coordination in place for all high risk patients.
New models of care in place for all population segments, across system. Evaluation of impact of early- implementers used to guide roll out.
PCNs take collective responsibility for available funding. Data is used in clinical interactions to make best use of resources.
Primary care providers full decision making member of ICS leadership, working in tandem with other partners to allocate resources and deliver care.
The PCN has built on existing community assets to connect with the whole community.

23. PCN Clinical Director Role “A Practicing Clinician from within the PCN”
Represent the PCNs collective interests
Implementing strategic plans
Work collaboratively with CDs from other PCNs to shape and support to ICP
Strategic & clinical leadership for the PCN
Develop a PCN workforce strategy
Implement agreed service changes and pathways
Develop local initiatives to reflect local needs
Develop relationships internally and external to the PCN
Facilitate participation by practices in research
Represent the PCN at CCG and ICP level
Lead role in developing PCN conflict of interest arrangements

24. The Immediate Tasks to Establish PCNs
By 15 May networks will need to make a brief submission outlining:
the names and the ODS codes of the member practices;
the network list size, i.e. the sum of its member practices’ lists as of 1 January (justification required if not 30-50k);
a map clearly marking the agreed network area (justification required);
the initial Network Agreement signed by all member practices (see below);
the single practice or provider that will receive funding on behalf of the PCN; and
a named Clinical Director from within the GPs of the network
Between May and June - National and local joint work between NHSE, CCGs and LMCs to resolve outstanding Issues
1st July – All networks go live and funding flows

25. Four Definitive Documents – 29th March
The Network Contract DES
Network DES Guidance for 19 / 20
Mandatory Network Agreement
The Network Contract DES and VAT

26. Key Messages Immediate issues for PCNs
For 2019/20, the network must agree how they will deliver the requirements of the Extended Hours DES for the whole of the network population
Need to agree the additional staff roles they require
Need to sign a Data Sharing Agreement (Template to follow)
Mandatory Network Agreement (to be submitted by 30Th June) needs to specify:
Decision Making – What is to be decided, how decisions will be made, who attends meetings, voting arrangements and record of decisions taken
Additional Terms the PCN may wish to make (voluntary – but secondary to mandatory clauses)
Activities – who does what in terms of network activities – service levels & monitoring
Financial Arrangements – who gets paid for what activities, how is income divided
Workforce – engaging and employing additional staff roles
How the Network works with other organisations

27. So How Prepared are you in Your Area?