The NHS Long Term Plan, GP Contract Framework and Primary Care Networks A collaborative event between Barnet CCG, LMC and Barnet GP Federation Barnet GP Forum Wednesday 10 April 2019
AGENDA PAN BARNET EVENT 10 April 2019 12:30pm – 5:00pm The 100 Club, Allianz Park, London, NW4 1RL Item Presenter Timings REGISTRATION, LUNCH AND NETWORKING 12:30 - 1:00 Welcome and Introductions CCG, Fed, LMC 1:00 - 1:10 NHS Long Term Plan and GP Contract framework Colette Wood, CCG 1:10 - 1:20 1:20 – 1:40 Primary Care Networks (PCN) Greg Cairns, LMC Dr Charlotte Benjamin, CCG The Local Barnet Context and Timelines 1:40 - 2:10 Colette Wood, CCG 2:10 – 2:30 Barnet Federation Barnet Federated GPs 2:40 – 3:00 Slido Q&As CCG, Federation, LMC BREAK 3:00 - 3:20 Table Discussion Table discussion 3:20 - 4:00 Plenary – Table Feedback (1 - 2 points) Dr Charlotte Benjamin, CCG 4:00 - 4:15 Thanks and close Dr Charlotte Benjamin, CCG 4:15 - 4:20
Welcome, Aims and Objectives • To understand Primary Care Networks in the context of wider GP Contract reforms and the NHS Long Term Plan: headlines and timelines • Present and discuss guiding principles and options, challenges and opportunities related to the formation of Primary Care Networks in Barnet • Understand what you need to do – now and in the future • Identify available support and know how to access it
Background and Context The NHS Long Term Plan and Investment and Evolution – a five-year framework for GP contract outline a coherent national policy and strategic direction for developing primary care, and making it sustainable. • In June the Government announced there would be an additional £20bn a year investment in the NHS by 2023/24 • The Long Term Plan (LTP) was issued 07 January setting ✓ Preparing primary care to play a role in designing and driving a future ICS out a ten-year strategy and direction of travel for NHS, focus on prevention, improvement and efficiency and ✓ More integration of community better integrating primary and community care services with primary care – operational model and roadmap must • National clinical priorities: children and young people, be clear and agreed. Requires cancer, cardiovascular disease, stroke, diabetes, significant transformation respiratory disease and mental health. Primary care has ✓ More coherent and aligned key role in making progress in relevant outcomes areas arrangements for workforce development, education and training • All of England covered by Integrated Care Systems (ICS) needed by April 2021, based on foundations built by PCNs – ✓ Focus on digital; covers patient self- groups of GP practices covering 30 – 50,000 people service, access, consultation methods approx. and better use of data.
Background and Context The NHS Long Term Plan and Investment and Evolution – a five-year framework for GP contract outline a coherent national policy and strategic direction for developing primary care, and making it sustainable. Contd.. What we know: • The new GP contractual framework was announced 31 January; first step towards operationalising the Long Term Plan. Framework covers eight areas: 4. Network 1. Workforce 2. Indemnity 3. QOF contract DES 6. New 8. Research and 5. Digital and networked 7. Investment future contract access services changes • Large funding injection for primary care; much of the funding contingent in participation in Primary Care Networks (PCNs) via a DES • PCNs are groups of general practices working closely together, with other primary and community care staff and health and care organisations, providing integrated services to their local populations. • PCNs to deliver defined services DES service specification released 29 th March 2019 •
Guiding Principles for table discussion Different forms/ levels of integration and service provision will be required at different levels Integrated care system alliance of commissioners and providers across health and social care; population based and outcomes focused within a shared budget At-scale primary care provider delivering efficiencies of scale and leadership support; providing a voice for integration across boundaries of care The primary care network geographically contiguous teams of practices caring for 30,000-50,000 people; delivery of data-driven integrated multidisciplinary team based services. The practice continues to provide core services, which are resilient and sustainable; coordination and planning of holistic, personalised, accessible care The person supported by families and local communities; enabled and empowered to access care in a way which works for them, based on ‘what matters’ to them 6
Primary Care Networks: Guiding Principles Guiding principles include: - Place has primacy – practices within PCNs should be geographically contiguous - Size of networks suggested at 30,000-50,000 population ; balancing critical mass and making professional relationships work - There should be 100% coverage ; CCGs have a role in confirming the full PCN configuration - All practices eligible to participate in the PCN DES; weighted Network Participation Payment of £1.76, (alongside Global Sum) - Viability of PCN delivery model is key. Current national guidance: could be through lead practice, GP federation, NHS provider or social care enterprise - Each network must appoint a Clinical Director - Level of responsibility involved: e.g. service delivery, workforce, financial management and governance - PCNs will want to consider : decision-making, accountability, data sharing, dispute resolution, HR, finances etc 7
Any questions so far? Slido Questions: https://www.sli.do/ Code: #8680
GP Contract Agreement 2019/2020 Primary Care Networks www.lmc.org.uk
Primary Care Networks Contract specification: • Is a DES (Network Contract DES), spec applies to year one • Accessed by Primary Care contract holder – GMS, PMS, APMS • Begins 1 April, requirements apply from 1 July 2019 • Part of larger package re Long Term Plan • Funding to form and develop PCNs, additional workforce • PCNs to deliver defined services • DES specification published 29 March 2019 • CCGs may add contracts for enhanced services to the Network Contracts DES, in discussion with LMCs and practices www.lmc.org.uk
What this means “The Network Contract DES specification must not be varied locally and commissioners are not able to increase or reduce the basic requirements nor reduce the national funding pursuant to this Network Contract DES specification.” “Commissioners and LMCs will need to work closely and in partnership…This will include ensuring any patients with a GP practice not participating are covered, e.g. through a Local Incentive Scheme” www.lmc.org.uk
Structure and Coverage Key messages: • Cover @30-50,000 patients. • Should be ‘geographically contiguous. • Can overlap, but must ensure full population coverage. • Based on collaboration, relationships within PCN, with other providers. www.lmc.org.uk
PCN Governance (i) • Practices are core members. • Based on collaborative working, underpinned by Network Agreement. • Legal and contractual status. • Will have a Clinical Director, decided by PCN (funding based on size). • PCN decides how funding/workforce deployed, and who it flows funding to (e.g. sub-contracting) • Consider VAT/Liabilities issues (BMA PCN Handbook) www.lmc.org.uk
PCN Governance (ii) • CCG confirms PCN configuration. • CCG confirms network population coverage. • CCG approves variation to GP contract (GMS/PMS/APMS). • PCN to provide services via DES; delivery based on Network Agreement. • PCN makes decisions & determines decision making processes. • Collaborative working with other organisations by invitation (e.g. Community Providers). www.lmc.org.uk
PCN Establishment • 29 March – PCN DES Spec, DES guidance, DES registration form, Network Agreement 19/20 and network contract VAT information note issued. • 15 May 2019 – initial registration submission (names, list size, geography, draft Network Agreement, funding arrangements via named lead provider*, named Clinical Director). NB funding via Nominated Payee; must hold primary care contract • Full signed Network Agreement by 30 June • 1 July 2019 – Network Contract live. • 2019 – amended SFE, Regulations in place. www.lmc.org.uk
PCN Registration • Initial submission: By 15 th May 2019 • Names of proposed member GP Practices • Practice ODS Codes • PCN/Practice list size @ 1 January 2019 • Map of geographical area • Initial Network Agreement • Single practice/provider to receive funding on behalf of PCN – Nominated Payee • 31 May, CCGs confirm PCNs, coverage www.lmc.org.uk
PCN Network Agreement ‘Mandatory’ Network Agreement will set out: • How practices will work together. • Which practice(s) will deliver what. • How funding will be allocated. • How new workforce will be shared. • Patient involvement. • Any other agreements e.g. pooling of practice funding. • Data sharing arrangements. • Conflicts of interest. • Decision-making, meetings. • Joining/leaving arrangements. www.lmc.org.uk
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