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New GP contract to mandate practices to join primary care networks

by Sofia Lind
7 January 2019

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GP practices in England can expect changes to their contract from April mandating them to join networks of 30-50,000 patients in return for a major funding boost, our sister publication Pulse has learned.
The BMA’s GP Committee is in the final stages of negotiating the changes following the long-awaited publication of the NHS long-term plan, which will see primary and community care receive an extra £4.5bn by 2023/24.
The new contract is also likely to see changes to QOF and a review of funding the immunisation schemes, the long-term plan says.
Under the plans, all local enhanced services are likely to be funded by CCGs through the networks.
GPC chair Dr Richard Vautrey told our sister publication Pulse that the 2019/20 contract changes, which have yet to be signed off, will require practices to join primary care networks but that no practice would need to give up their GMS contract as a result.
The long-term plan says that the ‘vanguard’ programme – which saw GPs working in networks and covering larger patient groups – has been successful and can now be rolled out across England.
As a result, GP practices will be told to enter into a network contract ‘as part of a set of multi-year contract changes’, and ‘as an extension of their current contract’.
The plan says: ‘The £4.5bn of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people.
‘As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow.’
It adds: ‘Most CCGs have local contracts for enhanced services and these will normally be added to the network contract.’
The networks will have ‘expanded neighbourhood teams’, which the plan says ‘will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists, joined by social care and the voluntary sector’.
The number of link workers in primary care networks will also increase, with over 1,000 trained social prescribing link workers expected to be in place by the end of 2020/21.
The plan suggests other changes to the GMS contract, including:

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  • Changes to QOF, which will see a new Quality Improvement (QI) being worked up with the RCGP, NICE and the Health Foundation, while the ‘least effective indicators will be retired’.
  • A ‘ fundamental review of GP vaccinations and immunisation standards, funding, and procurement’ in 2019 in a bid to improve immunisation coverage.

Dr Vautrey told our sister publication Pulse: ‘Practices are already starting to develop networks covering 30-50,000 patients. This is a contractual change that will facilitate and support that. We will have more detail on that as soon as we finalise the contract.
‘Every practice will be part of a network. How they engage with that will be for them to determine but I would hope that the contract changes will make it beneficial for them, to be part of working with colleagues across an area.’
He added that this would mean ‘retaining your GMS contract’.
‘This builds on this contract and will not replace it. Nobody will have to give up their existing contract,’ he said.
NHS England said in 2017 it was expecting ‘100%’ of GP practices to cover networks of 30-50,000 patients by ‘around 2019’.
Commenting on the long term plan, RCGP chair Professor Helen Stokes-Lampard said: ‘We know that working in larger groupings can be beneficial in terms of increased peer support, building resilience in the system and working more collaboratively – and PCNs build on models that have been shown to be successful.
‘However, it is vital that this is done in a way that minimises disruption for hard pressed GPs and their practices and enables progress to be made in a way that protects the ability of GPs to deliver care in the way that best meets the needs of their local communities. It is also vital that continuity of patient care is prioritised.’
A version of this story was first published on our sister publication Pulse.