Part one: Primary Care Networks - key points for general practice

Primary Care Networks form a key component of the Long Term Plan. The Network Contract DES (Network DES) was released on 29 March 2019 and takes at-scale working in general practice to the next level. Practices will now need to come together quickly to agree network arrangements and then ensure they work effectively.

The Network DES will evolve annually until at least 31 March 2024, with five new specifications to be added for the contract year 2020-21. Should practices wish to access additional funding available under the Network DES, there are now set deadlines for implementation as detailed below:

For assistance with implementation, the key documents available are:

1. the Network Contract DES Specification, which sets out the service requirements for the overarching agreement
2. the Network Contract DES Guidance, offering advice and information on the contract, on which practices and commissioners must rely
3. the mandatory Network Agreement, which is the mandated front end of the agreement between practices forming networks
4. the template Network Agreement Schedules, which offer a structure for additional terms (financial arrangements and workforce etc), but are to be negotiated between, and agreed and populated by, practices forming networks

Network list sizes expected to be up to 50,000 patients per network – with a lower limit of 30,000 patients, most networks will be smaller and therefore, where practices are federated, will sit below federation level.

Networks will be required to appoint a named network clinical director, to be responsible for clinical leadership and strategic planning. The network clinical director will also be required to work with clinical directors from other nearby networks, commissioners and the local STP or ICS as appropriate. 

Service requirements and payment

The initial service requirement for the Network DES will consist of:

• additional clinical sessions available to listed patients, outside of network practices’ core contract hours
• extended hours access taking into account patient preferences based on available data (note this is remunerated separately)
• additional routine appointments of a minimum of 30 minutes per 1000 registered patients per week (25 hours per week for 50,000-patient networks)
• extended hours appointments by member practices (or appropriately sub-contracted extended hours appointments) in continuous periods of at least 30 minutes per week, including sickness and leave cover

Available funding

1. Service payment: payment for the Network DES service requirements is £1.761 per weighted patient per year (or £0.147 per weighted patient per month), which equates to £88,050 annually for 50,000-patient networks. Extended hours access is remunerated separately
2. Core network funding: Core funding for the network is a payment of £1.50 per patient on the practice networks’ list as at 1 January 2019 per annum, which equates to £75,000 annually for 50,000-patient networks
3. Extended hours access funding: From the 2020-21 contract year, extended hours access is funded by a payment of £1.45 per patient on the practice networks’ list as at 1 January the previous year. For the 2019-20 contract year, the payment will be £1.099 per listed patient per annum (pro rated 1 July 2019 to 31 March 2020). In the first contract year, this would equate to £54,900 annually for a 50,000-patient network
4. Network clinical director payment: Payment for the network clinical director is assessed on patient list size at 1 January 2019 and is based on a 0.25 WTE equivalent (with one WTE being £137,516 in the first contract year). This equates to £0.514 per listed patient per annum (pro rated 1 July 2019 to 31 March 2020), which in the first contract year would equal £25,650 for a 50,000-patient network
5. Additional roles reimbursement sum: Additional funding is available to enhance the workforce delivering the services. This is based on the principle of additionality, requiring networks to demonstrate additional roles have been created through the initial Network DES services/network’s existence. Reimbursement will be available for:

• clinical pharmacists – 70% of costs (a maximum of £37,810)
• first contact pharmacists – 70% of costs
• physician associates – 70% of costs
• first contact community paramedics – 70% of costs
• social prescribing link workers – 100% of costs (a maximum of £34,113),

subject to maximum amounts, available for the first five years of the Network DES.

Network implementation checklist

By 30 June 2019, for delivery of the Network DES services on 1 July 2019, primary care networks formed by practices must:

1. have nominated a single general medical services (GMS), personal medical services (PMS) or alternative provider medical services (APMS) contract-holder to receive payments (the nominated payee)
2. have a network agreement in place based upon the Network Agreement Schedules
3. appoint an accountable network clinical director, who is responsible for strategy and is expected to work with the local ICS or STP
4. have in place an appropriate data sharing agreement – a national template will be released in due course
5. engage appropriately with patients
6. have regard for subcontracting requirements under their respective practices’ GMS, PMS and/or APMS contracts if subcontracting the initial Network DES services, or other Network DES services going forward

Timeline for implementation

The important dates for your diaries are below:

Digital opportunities

The Network Contract allows for subcontracting (within the statutory framework underpinning practices’ GMS, PMS and/or APMS contracts), which may allow practices to increase their capacity to provide the initial Network DES services through subcontracting to other providers. Networks must still notify the commissioner of their intention to subcontract any services and commissioners will have the right to withhold consent to subcontracting when this is possible under the GMS, PMS or APMS regulations.

The specification states that a ‘reasonable’ number of the extended hours access appointments must be face-to-face, however it is clear that the remainder can be by phone, video, online or a mixture. This increases opportunities to capitalise upon the current trend of general practices and providers of online GP consultations partnering to further the digital healthcare ambitions set out in the Long Term Plan.

Online providers can grow their patient coverage and practices can offer their patients a further option to access care, as well as increasing their capacity to deliver out of hours service in delivery models sensitive to general practice funding.

Developing your Network Agreement

The guidance makes clear that commissioners will not be reimbursing professional advisors’ fees for practices seeking advice before entering into Network Agreements, however a number of federations are offering support to their member practices.

Many practices will already have infrastructure in place that can minimise the need to seek advice from advisors. For example, federated practices may be able to benefit from their federation managing the involvement of advisors. For those not already working together at federation level or under a MoU for inter-practice working, there are opportunities to examine and learn from models elsewhere to reduce risk as detailed below.

Read part two