NHS England has unveiled new financial incentives for primary care networks (PCNs) that meet certain targets ahead of others.
In a letter sent last week to stakeholders, NHS England revealed that networks who will complete the national service requirements ‘further’ and ‘faster’ will be offered additional funding.
From next year, all networks will have to fulfill the seven service specifications, which include areas such as enhanced health in care homes, supporting early cancer diagnosis and cardiovascular disease prevention and diagnosis.
It was reported earlier this year that networks in a ‘good position to make progress during 2019/20’ were set to receive up to £200,000 out of an earmarked funding envelope worth £3m.
But following criticism, with GPs calling the programme ‘elitist funding’, NHS England later decided to ‘formally’ scrap the controversial plans.
Instead, it has offered potential financial incentives to all networks.
The letter, sent by deputy director for PCNs primary care strategy and NHS contracts group Robert Kettell, said networks who deliver the seven national service requirements ‘further’ and ‘faster’ will receive extra funding.
Mr Kettell wrote: ‘In addition to the service requirements, changes in 2020/21 will include the introduction of the Network Dashboard and the Impact and Investment Fund which will complement service requirements. The service specifications will set minimum requirements within the directed enhanced service (DES). The dashboard will include measures of success to allow PCNs to benchmark their performance and monitor their delivery of the five service specifications.
‘The Impact and Investment Fund (IIF) is expected to provide additional funding to PCNs which go further and faster to deliver the national service specifications and provide an incentive for PCNs to reduce unwarranted demand on NHS services, including overprescribing and inappropriate A&E attendances.’
Under the new networks contract DES, PCNs will be responsible for the delivery of seven national service specifications, which include:
- Structures medications review and optimisation;
- Enhanced health in care homes;
- Anticipatory care;
- Personalised care;
- Supporting early cancer diagnosis;
- Cardiovascular disease prevention and diagnosis;
- Tackling neighbourhood inequalities.
‘It feels unrealistic’
Lancashire and Cumbria local medical committee (LMC) chief executive Peter Higgins said he is concerned over the number of expectations placed on PCNs.
He said: ‘I am concerned that expectations on PCNs grow each day. The contract agreement and, within it the additional roles reimbursement scheme, were meant to address the severe workforce shortages and under investment in primary care. The expectation is that PCNs will require additional roles to meet the requirements of the seven service specifications but practices have to find 30% of the funding themselves.’
He added: ‘I had hoped that the IIF, albeit retrospective, would plug this funding gap, but it sounds like PCNs are expected to go above and beyond the requirements of the service specifications to get their hands on this money. It feels unrealistic and I worry it will put many practices and PCNs off. We need to nurture and develop PCNs and not demand too much in these early days.’
‘A measure for success’
Dr Scot Richardson, a GP partner and PCN clinical director in Hull, said: ‘The IIF provides primary care with resource to ensure they are able to contribute and assist with the delivery of the long-term plan and effectively make real benefits for patients and our workforce. Within our PCN we are excited by this opportunity and welcome the dashboard as one form of a measure for success.
‘We, however, acknowledge that primary care is one part of the system and while we are committed to reducing unwarranted demand on NHS services this must be done collaboratively and the onus cannot [be] purely on primary care to solve this.’
NHS England said the funding for the specifications will ‘develop over the subsequent four years following further engagement and discussion.’
Mr Kettell said: ‘NHS England is developing proposals for the first year of the operation of the IIF, ahead of formal contract discussions with GPC England.’