Primary Care Network Workshops Tuesday 2 nd , Wednesday 3 rd and Thursday 4 th April 2019
Agenda Lunch and Registration 13:00 Welcome 13:30 13:30 Primary Care Networks • What are they? • What needs to be done. Federations how can they support? 14:10 Primary Care and Community Services Integration 14:20 Panel Q&A 14:30 Tea and coffee 15:00 Primary Care Networks space 15:00 Next Steps 16:30 Close 17:00
Dr Kiren Collison Clinical Chair Oxfordshire CCG
Aims for today 1.Background 2.Practical next steps 3.Questions 4.Time with your proposed PCN 5.More questions and discussion 6.Any issues? What further support?
• Don’t panic • This is a 5 year plan • CCG and LMC are here to guide you through it
Context • The NHS Long Term Plan • The GP contract reform • Primary Care Networks (PCNs) are a key part
What is a primary care network? Local Community of 30,000-50,000 Wider Working with other Health, Care and 3 rd Sectors Working with other practices Practice
The bigger vision McGovern L, Miller G, Hughes-Cromwick P. Health Policy Brief: The relative contribution of multiple determinants to health outcomes. Health Affairs. 21 August 2014. Available from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_123.pdf
What are PCNs designed to do? 1. Use data to design services around the needs of the population 2. Proactive, coordinated care Prevention Health inequalities 3. Connect patients to other services (e.g. health, care or third sector) 4. Support the whole system
Why should we sign up? • PCNs shown to be successful elsewhere • Funding increasingly channelled into PCNs • Lose out on funding if opt out • Greater influence
Potential challenges • New way of working Doing a lot for the first time • Relationships and possible disputes • Clinical Director responsibilities • Management and admin capacity • Data • Workforce - recruiting, supervising, liabilities, costs • Legal and tax advice
How are we going to get there? • ‘Ground-up’ approach • CCG and LMC to support practices • Network Contract DES - vehicle for general practice taking a leading role in every PCN
PCN DES Workforce 7 specs Funding System
1) Additional roles • Additionality rule • New roles added from 20/21 • From 20/21 reimbursable rate calculated based on weighted population
2) Funding Practice Support Practice participation (£1.76/weighted pt/year direct to practices) Network Support • Core PCN funding (£1.50/head for 19/20) • Clinical Director (£0.51/head for 19/20 then £0.69/head) Access • Extended hours DES (£1.099/head for 19/20 then £1.45/head) • Improved access (GPAF) (~£6/head) from 2021 Investment and Impact • Further details awaited Fund
And in return… 7 national specifications: 2019 2020 2021 • Extended Hours access • Structured medication • Cardiovascular disease integrated into networks review prevention and – 100% of network • Enhanced health in care diagnosis, through case 2019 population homes finding • Anticipatory care (with • Action to tackle community services) inequalities • Personalised care • Supporting early cancer 2020 diagnosis 2021
Plus… • Support the system • Making best use of resources • Engagement with patients – including ‘seldom heard’ • Additional services based on local need
Tuesday 2 April Wednesday 3 Thursday 4 2019 April 2019 April 2019 Dr Raman Nijjar Dr Matt Mayer Dr Richard Wood Chair Chief Executive Officer Chief Executive Officer Oxfordshire LMC Oxfordshire LMC Oxfordshire LMC
Next practical steps
Forming a PCN • Size • Restrictions: – Geographically Contiguous – No doughnuts! • Nominated Payee
Clinical Director & Governance • Clinical Director – Who • Clinician working within your PCN. • COIs – How • Governing Body – How are practices represented? – How do you make decisions? – Other concerns
PCN Structure • Workforce • Pensions • VAT • Contractual liabilities
“ We’ll all pitch in” Pensions Liability ! VAT CQC
“ We’d like one of our practices to lead on this” Pensions Liability ! CQC VAT ! Easier for most Incentive for the keen
“ We’ll ask our federation to do this” Liability ? VAT ! Managerial ? Pensions ! Easier for most ? CQC !
“ We’ll team up with our local 4. community trust who can help us deliver this” Pensions VAT ! CQC ?GP Autonomy ! Easier for most Liabilities Diverse staff
Network Agreement • Clauses – sign by 15 th May • Schedules – sign by 30 th June – Schedule 1 : Network specifics and meetings – Schedule 2 : Additional Terms – Schedule 3 : Activities (e.g. KPIs) – Schedule 4 : Financial Arrangements – Schedule 5 : Workforce – Schedule 6 : Insolvency – Schedule 7 : Arrangements with organisations outside network • You need to keep this up-to-date!
Dr Kiren Collison Clinical Chair Oxfordshire CCG
Timetable for DES introduction https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf
Developing support • CCG Locality meetings : discussions at the January and February meetings • CCG and the LMC : discussions on the significance of the contractual developments • CCG, GP Federations and Oxford Health: discussions as potential delivery partners in the PCNs
Ongoing support to PCNs • PCN workshops • 3 sessions per practice (£900) • 1 session per week per PCN (for 10 weeks) – Early indication of PCNs – Engagement in June integration workshop • Integration workshops – June tbc • Integrated multidisciplinary working workshops • Development of support programme locally and by NHSE • CCG locality meetings to advance, support and share learning • FAQs
Tuesday 2 April Wednesday 3 Thursday 4 2019 April 2019 April 2019 Dr John Harrison Andrew Elphick Helen Shute Chairman Chief Executive Officer Chief Executive Officer PML PML OxFed
Tuesday 2 April Wednesday 3 Thursday 4 2019 April 2019 April 2019 Pete McGrane Tehmeena Ajmal Clinical Director, Community Lead for Primary & Community Integration Oxford Health NHS Oxford Health NHS Foundation Trust Foundation Trust
Panel Questions
Breakout questions • Who will be chosen as accountable clinical director? Will the job be shared? • How will the process take place? By appointment or by election? How would voting work? • Who will receive funding on behalf of the PCN? • How will you decide what goes into your network agreement (decision-making processes, employment model, accountability)? • Any issues that need to be resolved before 15 th May?
Next steps
By 15 May • The Names and the ODS codes of the Member Practices. • The Network list size , as of 1 January 2019 • A map clearly marking the agreed network area • The initial Network Agreement • The single practice or provider that will receive funding on behalf of the PCN • The named accountable Clinical Director
Do you need further support? • Reading to help you: – GP Contract – BMA Handbook – FAQs • Contact the LMC ceo@bbolmc.co.uk • Contact the CCG occg.pcn@nhs.net
• Don’t forget: you can use your partnership agreement for a lot of the schedules. • Also, note: CCG-funding for time in lieu can now be used for legal advice instead. £900 per practice + £3000 per PCN!
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