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What are the funding implications of the new network DES?

4 April 2022

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On 1 April, NHS England released the long-awaited new Network DES. Much of this we already knew, but it filled in some details around the requirements for the enhanced access scheme, the new service specifications for personalised and anticipatory care and the use of mental health practitioners. It also clarified the funding available for practices who participate in the DES. We look at what this will mean for PCN funding.

Boost to ARRS funding

There are two hugely significant boosts to PCN funding through the additional roles reimbursement scheme and the Impact and Investment Fund.

The ARRS funding for the coming year increases to £16.70 per patient, up from £12.30 – representing the equivalent of £132,000 more for a network of 30,000 patients. In total, the same size network will receive almost exactly half a million pounds’ worth of funding for additional roles in the coming year.

The maximum amount that networks can spend on each particular role has stayed pretty much the same, with one notable exception – PCNs can now appoint two mental health practitioners if they have the approval of the local community trust, and four if their list size is larger than 100,000.

However, this funding is not always guaranteed. As networks have struggled to fully utilise their total ARRS allocations, this is often simply lost money. So, the extra funding – which was already announced previously – shouldn’t be wildly celebrated.

Chief executive of Lancashire and Cumbria consortium of LMCs Peter Higgins says: ‘The two new service specifications on anticipatory care and personalised care are funded through the ARRS route, but you try and find and recruit to those roles, it’s not always possible. That in itself is over bureaucratic and over-constraining because those pay rates haven’t changed either.’

Partner at RBP accountants Kate Perry tells Pulse: ‘With ARRS, I would say that it falls quite far short of what GPs were hoping for. I think they were hoping for a lot more flexibility in the use of that money because they’ve been quite specific with what that money can be used for. And for practices in all sorts of areas, it’s not really covering the staff they feel they need.

‘It’s fine throwing all this money at the system, but the staff aren’t there to recruit. I’ve had loads of my clients saying that they’ve extended the working week for GPs, but they can’t even find locums to cover the hours they’re trying to cover now.’

Increased Impact and Investment Fund

There is also a huge amount of money that will be funnelled through the IIF – which is crudely a network-level version of the QOF. The value of an IIF point remains at £200, but the number available will increase from 389 to 1,153.

Many of these points relate to the service specifications: CVD prevention, enhanced care home care, cancer, personalised and anticipatory care. But there are also new indicators on tackling health inequalities and, most controversially, improving waiting times.

Non-routine hours appointments

When you look past the various confusingly named pots of funding for practices to open beyond 6:30pm and at weekends, the picture is unchanged for most practices and networks.

There was a fear that practices and networks would miss out on funding when the CCG enhanced service and the national enhanced service were merged. But, as per the letter from NHS England at the start of March, it looks like there won’t be much impact.

Networks now have a single stream of funding that incorporates the £6 per patient they received from CCGs and the £1.44 they received for the national service (although it shouldn’t be forgotten that this was £1.90 at one point). They also have a clear set of requirements too. This equates to £7.46 per patient.

However, this is a compulsory part of the DES. It is clear that PCNs can’t opt out of this service. If they don’t satisfy the requirements, the commissioner can withhold not only this payment, but also the core funding worth £1.50 per patient.

Ms Perry says: ‘The numbers for the enhanced access fall way short of really what they need to be. They’re being asked to just do more for not much pay. All it’s going to do is be another straw on the camel’s back.

‘I don’t think it’s going to be received particularly well, it doesn’t feel like it’s trying to help. All it’s done is load more criteria on an already very stretched service.

‘The enhanced access will just be a complete heart sink for GPs. They can’t fulfil the expectations of the patients and this is adding to this.’

Much funding unchanged

The news of the cost-of-living crisis and inflation hasn’t seemed to have permeated NHS England and the Government. Much of the core funding remains unchanged. For example:

  • Core PCN funding – the payment for participating in the DES – remains at £1.50 per patient;
  • Clinical director payment remains at £0.74 per registered patient;
  • The care home premium remains at £120 per bed per year, based on CQC data.

But inflation will be a huge factor in general practice. As Ms Perry puts it: ‘They’ve said inflation is expected to rise to up to 8%, and this has not addressed that situation at all, nor has it addressed the fuel crisis situation.’

One clinical director based in the South West says: ‘At first glance, the latest update to the Network DES contract falls short of providing the much-needed support to general practice at a time of unprecedented demand against a backdrop of critical workforce pressures in primary care. NHSE has failed to recognise the very different landscape we find ourselves in since the pandemic, ploughing on with a contract first negotiated in a very different pre-pandemic world, and refusing to negotiate or agree any of these latest changes with the BMA’s GP Committee England.

‘With no increase in PCN core funding or clinical director reimbursement this year (not even a cost-of-living rise that is usually added to the GMS baseline), PCNs will struggle to retain the clinical leadership that is vital for driving the changes required and to be a strong voice in future Integrated Care Systems.’

Mr Higgins says: ‘[The payments] are not uplifted for inflation. Effectively, it’s a pay cut, because practices are already going to struggle with the inflation uplift that they have been given, as opposed to what real inflation is. 

‘The other things are the minimum wage, that’s causing a lot of problems for some practices in terms of meeting it, and also keeping pay differentials. That’s a headache for some practices, and of course, the National Insurance contributions that go up. None of this has been reflected for general practice. In terms of PCN work, practices need to start thinking, is it worth doing this?’

There is nothing in this contract that will change the analysis put forward by the BMA that practices should consider whether they want to continue with the DES. There is a whole new tranche of funding, but much of it comes with either more work attached – ie, the IIF – or is not guaranteed, in the case of the ARRS.

However, it remains clear that any new funding that is coming to general practice will be put into PCNs, leaving practices with a dilemma. NHS England will be hoping that networks don’t vote with their feet before the deadline to sign up of 30 April.

Additional reporting: Caitlin Tilley

This article was initially published on our sister title Pulse.

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