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Practices given £2 per patient to join networks under new DES

by Elisabeth Mahase
31 January 2019

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A new directed enhanced service (DES) will provide practices with an average uplift of £14,000 to join a primary care network as part of the new contract announced today.
The BMA and NHS England said they expect 100% of practices to join the networks, which will be based on geography, and they will simply need to choose a lead and implement governance processes to qualify for the funding from July. 
In following years, seven ‘service specifications’ will be gradually implemented as part of the DES based on the clinical strategies set out in the NHS long-term plan, including increased screening and earlier detection of cancer.
The primary care networks – which will cover 30,000 to 50,000 patients and be led by a local GP in a clinical director role – were announced earlier this month, with practices being mandated to join them in return for a £4.5bn funding boost.
There will be alternate arrangements for rural practices in ‘exceptional’ circumstances, the BMA GP Committee chair Dr Richard Vautrey said.
He added that ‘common sense’ would be applied in cases where practices are already part of groupings that are more geographically diverse.
In the first year of the DES, practices will be given the £2 per patient to join the networks. From 2020 they will need to work towards these aims from the NHS long-term plan, including:

  1. Structured medicine reviews
  2. Delivery of enhanced support to care homes
  3. Proactive care for patients at greatest risk of hospitalisation
  4. Personalised care, including shared decision-making and personal budgets
  5. Support in early diagnosis of cancer, including increased screening
  6. CVD detection and case finding
  7. Tackling health inequalities

More detail is set to be released imminently, but it has been announced that there will be a new data service focusing on these service specifications.
NHS England will also fund an ‘army’ of 20,000 extra staff to support GP practices, as part of a local primary care networks, it said.
The new staff, which will include pharmacists, physiotherapists, paramedics, physician associates and social prescribing support workers, will free up GPs to spend more time with patients who need them, it explained.
Earlier this week, NHS England announced primary care networks will be supported by 1,000 social prescribing workers by April 2021.
According to the BMA, networks will receive ‘100% recurrent funding to employ social prescribers and 70% for clinical pharmacists this year, and the same for physiotherapists, physician associates and paramedics as they are introduced’.
BMA GP committee chair Dr Richard Vautrey said: ‘Support and funding for primary care networks mean practices can work together, led by a single GP, and employ additional staff to provide a range of services in the local area, ensuring patients have ready access to the right healthcare professional, and helping reduce workload pressures on GPs.
‘This significant expansion in the workforce, which will eventually see over 20,000 healthcare staff based in networks across England, will also be expected to focus on some of the long-term plan’s commitments, such as support for care home residents and the earlier identification of people with cancer or cardio-vascular disease.’
NHS England chief executive Simon Stevens said: ‘This five-year deal unarguably represents the biggest boost to primary care in more than fifteen years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services.
‘It provides the practical foundation for the big service improvements in the NHS long term plan. Patients across England – in towns, villages and cities – will all begin to see the benefits, beginning this year. And it allows us to keep all that’s best about British general practice while future-proofing it for the decade ahead.’
RCGP chair Professor Helen Stokes-Lampard said: ‘Primary care networks have been shown to be beneficial in terms of increased peer support, building resilience in the system and pooling resources.
‘It is vital that these networks are GP-led, prioritise continuity of care for those patients who need it, and are implemented in a way that minimises disruption for hard-pressed GPs and our teams and protects the ability of GPs to deliver care in the way that best meets the needs of their local communities.’
CCGs have been told to ensure that the new primary care networks, which all GP practices will be mandated to join, are in place by 30 June at the latest.
NHS England planning guidance for the year ahead said CCGs must commit to spending a recurrent £1.50 per head of population on ‘developing and maintaining’ the primary care networks.
Speaking to our sister publication Pulse in an exclusive interview earlier this month, health secretary Matt Hancock said primary care networks will support GPs to be spend more time on ‘what they are trained to do’.
Meanwhile, NHS England claimed a pilot primary care network set up with GP practices in Luton saved 3,000 appointments and £50,000, while also improving patient satisfaction.
This story was first published on our sister publication Pulse.