With just over four months remaining of the five year Network Contract Directed Enhanced Service (DES), primary care networks (PCNs) will undoubtedly be looking to what the future may bring with regard to

• the network DES services
• additional reimbursed roles
• the associated funding for practices working at scale.

Whilst no formal announcement has been made regarding what will replace the DES after 31 March 2024, there have been assurances given over the past year.

The Fuller Report released in 2022 reinforced the benefits of the PCN model in acknowledging that “integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations and this is usually most powerful in neighbourhoods of 30-50,000”. It further added that “Integrated neighbourhood ‘teams of teams’ need to evolve from PPCNs, and be rooted in a sense of shared ownership for improving the health and wellbeing of the population”.

In May 2023, NHS England published its Delivery Plan for recovering access to primary care which acknowledged that integrating primary care requires general practice to operate at a larger scale either as part of PCNs or at place level and that this may require changes to the current arrangements. The additional statement that “[the] 2024/25 contract provides an opportunity, after the 2019 five-year framework ends and the PCN DES was introduced, to reflect on successes and lessons learned.” Doesn’t provide a great deal of certainty on what may lie beyond, but reassurance on continuity is present through the launch of the National General Practice Improvement Programme which included tailored support for Practices and PCNs over a two year period from 2023 to 2025. 

There is an expectation that PCNs will continue to be the foundation of ICS, but will need to keep evolving and adapting.

As always, it is important to ensure that there is robust governance in place underpinning relationships between practices as well as third parties. Taking stock of what your PCN is doing well and what areas can be built upon or strengthened will put your PCN in the best possible place in order to meet these new demands and grow into the NHS landscape as it develops.

Some areas of focus as we approach the end of the DES include the following:

PCN network schedules

As we approach the end of the five year DES, by now many PCNs will have revisited their original governance, possibly on more than one occasion.

There are many changes which have occurred in relation to the Network DES over time including:

• new ARRS (Additional Roles Reimbursement Scheme) roles
• the introduction of clinical services
• the Investment and Impact Fund.

Some PCNs have changed their membership over time and it is important that the network schedules reflect how the PCN currently operates and intends to operate. It is a possibility that the Network in its current form may be replaced with a successor regime which may require the existing arrangements to be brought to an end. It is important that your network agreement covers such eventualities and how to deal with any legacy arrangements and liabilities.

Third party relationships

Whilst there are examples of non-Core Network Practices becoming members of PCNs and brought within the governance arrangements of the Network Agreement and its schedules, many PCNs work with third parties, including GP federations or suppliers/subcontractors on an arm’s length basis. It is important to ensure there are robust contractual arrangements in place which enable the PCN to hold suppliers to account. These arrangements need to be clear on matters such as the nature of the services themselves, duration, cost, termination, performance indicators, management of disputes, whether TUPE applies, etc.

With subcontracted arrangements, it is important that any existing liabilities on the practices themselves, are properly passed down to the subcontractor. Relationships between PCNs and GP federations are deeply intertwined and many GP federations have been restructuring their governance around PCN localities of their GP practice membership. This requires careful planning and governance review.

Matters such as changes to access to the NHS pension scheme have required PCNs and GP federations to revisit contractual arrangements in order to maintain access to the scheme.

Staff relationship

As the number of ARRS roles increase, PCNs have been revisiting their employment models. Some PCNs have looked to build on their relationships and support provided by other providers including GP federations to employ the roles and provide the additional services.

Other PCNs have moved towards a PCN company model setting up a wholly owned company to employ ARRS roles and provide ancillary services to the PCN. Even where this has been kept “in house”, it may be beneficial to practices to standardise employment terms for new employees to ensure consistency and make it easier to manage for practices.

Financial matters

Having clarity on how funds are used, distributed/retained and what practices are entitled to both during the life of PCN membership as well as on leaving/expulsion is key in reducing the scope for dispute and costs associated with the same.

We would recommend PCNs use a specialist medical accountant, such as a member of AISMA, in ensuring the financial arrangements are robust both in terms of budget planning, accounting and distribution.

How Capsticks can help

Our primary care team advise primary care providers on a range of commercial and contractual arrangements as well as employment and engagement of ARRS roles within PCNs, including PCN incorporation and documenting arrangements between GP Federations and PCNs. This includes advising on structural options and network models, drafting a tailored and bespoke Network Agreement schedules for each PCN and advising on workforce, employment and HR.

If you or your PCN would like assistance with developing or reviewing your network arrangements, please contact Mark Jarvis.