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30,000-patient networks set to receive £1 per head more than larger networks

by Anviksha Patel
15 March 2019

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Primary care networks with a population size of 30,000 are set to receive £1 per patient more than 50,000-patient networks in 2019/20, according to new guidance from the BMA.
According to new BMA guidance, networks with 30,000 patients will receive around £4.59 – compared with £3.62 for networks with 50,000 patients – because all networks will receive the same amount of funding for pharmacists and social prescribers in their first years, regardless of size.
As well as providing an analysis of funding available to networks, the BMA guidance also lists the various structures that a network can employ – including a ‘flat practice network’, where commitments are spread across the member practices, and a ‘lead provider’ model, which would see a single practice taking on the bulk of the responsibilities.
The BMA guidance reviews the various pots of funding available to the new networks under the new five-year GP contract.
This includes: the network administration payment, which is ringfenced funding worth £1.50 per patient from CCGs; funding for a clinical director, which is worth 69p per patient; and the reimbusement for pharmacists and social prescribers.
All networks below 100,000 patients will receive the same amount of funding to employ a pharmacist and a social prescriber in their first year, meaning that smaller networks will receive higher funding per patient. Networks with more than 100,000 patients will receive funding to employ two pharmacists and two social prescribers.
However, in subsequent years, funding for other support staff – including pharmacists and social prescribers, but also physician associates, physiotherapists and paramedics – will be provided on a per capita basis.
Currently, groups of practices are advised to cover 30,000-50,000 patients but commissioners may sign off proposals for larger networks serving over a population of 50,000.
BMA GP committee chair Dr Richard Vautrey said: ‘The creation of PCNs, which delivers an additional £1.8bn in funding over five years, will offer tangible benefits and improvements to patients, GPs and the wider practice team through an expanded workforce to help reduce workload, and the BMA has been working hard to ensure that this process protects what makes British general practice so unique and valued.
‘There will understandably be many questions from practices as we approach July, and therefore we have produced this guidance to offer practical advice to GPs and their teams as they begin to establish networks that are right for them and their patients.
‘Many practices will already be working collaboratively, through informal networks, and we hope that our guidance will help them formalise these agreements to receive the full benefits of this year’s contract changes.
‘Indeed, no two networks will look the same, and our guidance provides suggested structures and ways of working that new networks can customize to meet the unique needs of their population.’
Speaking at Londonwide LMCs’ annual conference on Tuesday, GPC executive team member Dr Krishna Kasaraneni told delegates that he ‘wouldn’t say smaller is better necessarily for the sake of the size of things’ and that if a network is 90,000 and works for the practices then ‘that’s fine’.
He said: ‘The reason the 30,000 to 50,000 number came up was that that’s where things seem to be working where GPs are grouped together already. If you’re a 90-odd thousand and that works for you and that’s the size of network you want and that’s what the local practices have decided, that’s fine.’
He continued: ‘The advantages you gain in year one from being small will probably offset by dismantling something that works really well, that you probably ought to stick to.
‘It’s whatever works for you as practices locally. But if you have a size that big, what is expected in the contract is while you may sign a piece of agreement just based on your services around the local communities around delivering everything at that scale.
‘One of the perks of this contract is to provide services as locally as possible so not everything is a scale done in some hub, which is 50-20 miles away where the population lives.’
Primary care networks can be structured in several ways such as the flat practice network, which will have all practices using joint employment contracts and sharing equal liability.
Practices signed up to the DES can structure their network as a lead provider, which will allow one practice to oversee all contractual agreements and workforce arrangements.
Other structures include: the GP federation/provider entity structure formed of practices led by a federation; super-practice networks, which will cover practices with large populations over 100,000 patients; and non-GP provider employer models, which can operate through a local healthcare provider and will provide services on behalf of the whole network.
NHS England recently confirmed that primary care networks will not have to be led by GPs, because they’re clinically led, which means they could be headed by anyone with clinical experience.
GPs also warned this week that CCGs were trying to ‘manipulate’ new primary care networks to align with their own plans.