Primary Care Networks

Primary care networks - Frequently Asked Questions

Setting up a Primary Care Network (PCN)

We understand the pressures GP practices face setting up Primary Care Networks (PCNs) and the importance of getting this legally binding agreement right.

Our experienced team of over 30 specialist primary care lawyers are on hand to provide you with tailored legal advice and will work collaboratively with you to develop your plans, models, agreement and more. We can also support you by providing you with a data sharing agreement template.

Check out our latest PCN articles and our new PCN Legal Handbook to find out more, and subscribe to our free Healthcare Law Brief to ensure you're kept up to date on the latest legal changes in the healthcare sector.

For specialist legal support setting up a Primary Care Network, please contact Oliver Pool on 0117 314 5429.

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Frequently Asked Questions

What exactly should go into the PCN agreement and how detailed does it need to be?

A PCN Agreement is a governance document and will contain many of the provisions you would find in a partnership agreement, collaboration agreement or shareholders agreement.

The PCN should contain enough detail to avoid disputes and allow the parties to have a clear understanding of how the PCN will operate and what obligations, remedies and rights each party has. Obviously, including appropriate indemnities between parties is important as well as having clarity over how funding is held and distributed as well as how staff are intended to be employed and managed.

It is expected that the PCN will evolve over the first few years so it should not be overworked so much that change is more difficult to include, therefore it is important to find that balance.

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How will PCNs affect smaller practices?

As with any collaboration, PCNs can give smaller practices the opportunity to benefit from economies of scale and workforce sharing. PCNs can help smaller practices become sustainable and even open up opportunities, where appropriate for small practice to scale up their core practice via mergers.

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Should we have other documents in place which deal with specifics for our network dynamics?

The Network Agreement is the PCN's governance document but with any collaboration, there are likely to be other documents required depending on what the PCN is doing. Appropriate data sharing/processing agreements should be in place and a national template is still pending. The Activities schedule in the Network Agreement will set out the basis on which practice is doing what with respect to delivering the Network DES and this may well be a live schedule which needs to be regularly updated.

Other documents may include subcontracts with third parties where clinical services are being subcontracted, commercial agreements where non-clinical services are being bought and secondment/employment contracts for the provision of staff.

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Where is the CCG going to recycle the GP funding from?

Global sum increases have largely been from recycling the monies freed up from phasing out MPIG and seniority payments. The £1.76 per patient for participation in the Network DES is new money for new services, but one would expect other funding to come from relocating existing services (such as extended access).

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How do we make the most of the opportunity and bring benefits to patients without spending hours/money/energy on organisational form?

A balance will need to be struck and as with any venture or opportunity, there is benefit from ensuring at the outset that the form is fit for purpose. The risks of PCN joint working are likely to rise as the PCN matures over the years and the importance of having robust governance to protect the participants is the same as it would be in a GP partnership. Due to the fact that the PCN policy has been rushed in without thought to the changes in law which may be required, it is likely that the organisational form may change as we approach year 2. However, the expectation then is that the form will allow greater security for practices and the initial outlay in time and energy will pay off as the PCN matures, provided the parties are engaged.

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Does funding increase level of work within a PCN?

New funding for new services will involve additional work. The intention of funding attached to the employment of clinical pharmacists and social prescribers (and beyond) is to enable a broader service to be provided to patients and remove the burden on GPs by triaging patients to alternative non-GP clinicians.

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Will PCNs affect core contracts in the future?

PCNs sit over and above each practices' primary care contracts and whilst PCNs may in some areas lead to mergers between PCN practices, the most likely impact on core contracts will be the move towards Integrated Care Systems (ICS). On a practice level, many services appear that they will be commissioned within the Network DES which is contracted as a bolt on to primary care contracts. If NHS pension and VAT flexibilities in year 1 lead to PCN companies being formed, commissioning strategies may move towards commissioning new services under separate contractual arrangements with this new entity, rather than as a bolt on to existing primary care contracts.

PCNs are intended to be the foundation of all ICS but as primary care contracts are held on a practice basis and not network basis, the individual practices are still the key parties to this. The Integrated Care Provider (ICP) model envisages both a partially integrated model, where practices retain their primary care contracts but pool community services and also a fully integrated model where primary care contracts are subsumed within an ICP contract covering all healthcare services in a wider geographical area. The ICP contract remains under consultation and may be some way off for most geographies.

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Concerned that we will not be able to deliver Improved Access (IA) locally. What can we do?

If the PCN does not feel that it is able to deliver the Improved Access requirements through its member practices, then it will need to look to subcontracting these services to a third party.

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What is the VAT chargeable on social prescribers?

The VAT status of a Social Prescriber will vary according to the circumstances. Generally, where a Social Prescriber provides services through a GP practice, this will be an exempt supply for VAT purposes (although this depends on the precise arrangements). However, in the case of a PCN, the position becomes more complex since there will often be supplies of the Social Prescriber themselves made by the person employing the Social Prescriber and the other practices within the PCN. This could be potentially treated as a supply of staff, subject to VAT (if the person making the supply is registered for VAT) or might require the person making the supply to register for VAT.

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How do we transfer over already employed staff who has ultimate responsibility if the proverbial hits the fan?

A PCN cannot employ staff. There needs to be a lead practice (member) who will be the employer of new staff who are to be shared between the various members of the PCN, such as pharmacists, clinical directors, or physiotherapists etc. Some PCNs may decide to provide that the members jointly will be the employer. There are problems with this approach as it may be difficult to co ordinate control and such arrangements need to make sure no VAT issues arise through the supplying of staff. The employer will be responsible and accountable.

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Do we have an unlimited liability in case of an Employment Tribunal?

It is anticipated that within the PCN, each member who is not an employer will be expected to indemnify the lead practice as employer for the cost of employing staff, and meeting any Employment Tribunal claims. Members need to agree upon the basis of the indemnity and whether the extent of the indemnity is limited to use of the staff or otherwise.

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How will employing staff in a PCN work across practices?

The contract of employment will provide that the employee will work at the various sites/practices of the members as agreed between the members. Members will need to decide who has responsibility for supervision and direction whilst the employee is at a particular site.

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Liability for the practices in case of employment tribunals - I understand that if practices hold funds, they will have unlimited liability for workforce. Should this prompt us to use a limited liability vehicle like a federation which are private limited company?

The lead practice (member) will have liability for employment claims. Most employment claims are capped save for discrimination and whistleblowing claims. There is no reason why a private limited company cannot be created to employ staff and provide them to the members but such arrangements could amount to a supply of labour as opposed to healthcare services to the members and give rise to VAT issues. Furthermore such entities will not be able to provide access to the NHS pension.

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Is it beneficial to transfer existing pharmacist staff into the PCN?

A PCN cannot be an employer.

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What is the best approach in standardising employment T&C's across PCN practices?

The members need to consider who will be the employer and how the members will indemnify the employer member. The contract of employment will set out responsibilities of the employee towards the members. The members will need to decide upon the basis of exercising control.

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With liability of employing staff for the whole network, how would this work if a staff member is off sick, even though they make work across the network and you're left with the bill?

The indemnity between the members given to the lead practice if they become the employer will deal with members contributions to funding staff costs including all PAYE, sick pay and benefits.

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Will general practice become the data controller for all out of hospital activity?

A data controller is an entity which exercises control over personal data. It is possible to have more than one data controller for the same data, and it is likely that this will be the case for a PCN. For the individual members to be able to work effectively, each will need the ability to input their own information, but they will also need to be able to access and amend other patient information. For example, if a patient is referred from their GP practice to a physiotherapist who is part of the same PCN, the physiotherapist will need to access the patient records, and update them when treatment is given. The GP practice may then access the physiotherapist record when treating the patient in future.

The individual GP practices (and any other organisations that form part of the PCN) will remain data controllers in their own right of the personal data processed for their own purposes. If the structure of the PCN is such that it has a separate legal identity from the GP practices, the PCN will be data controller of any personal data where it determines the purposes and the means of the processing. Where the PCN and the individual GP practices jointly decide the purposes and means of the processing, then they will be joint controllers of that data.

Where the PCN does not have a separate legal identity from its members, the members will either share personal data between them on a controller to controller basis, with each responsible for its own processing, or they will be joint controllers (with joint responsibility for compliance with data protection legislation), depending on the nature and purpose of the processing activities.

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How do we ensure that existing data sharing agreements in place for EMIS are sufficient going forward?

Existing data sharing agreements between individual GP Practices and CCGs using EMIS will need to be updated to ensure that data shared within the PCN is covered within the permitted processing activities.

If the PCN does not have a separate legal identity from the members, the parties will need to ensure that all members of the PCN sign up to the data sharing agreement. Alongside the data sharing agreement, the members of the PCN will each need to ensure that their privacy notices cover sharing of data within the PCN.

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How we can help

Supporting you with a data sharing agreement template

We have produced a template data sharing agreement that you can use for your PCN as a stop gap, until the national template has been issued. Please contact us to find out more.

We also offer a fixed price package to support PCNs with their initial setup. This includes the following:

gathering information on the PCN members and their intentions so that we can advise on or "vet" your chosen or existing structure and ensure it is workable;
adding the relevant content to the Network Agreement to bring it to a stage where it can be signed;
ensuring that any employment contracts are structured in such a way as to minimise any VAT payable; and
advising on data sharing agreements.

We have also been supporting PCNs through face-to-face support sessions and have shaped our services around the needs and concerns of a range of GP practices and providers.

Advice should be taken in parallel from specialist medical accountants, and we can put you in touch if you do not already have the necessary support, or work with your existing advisers. We have close ties with AISMA and ICAEW and have been working closely with leading specialists in the sector to ensure a comprehensive and robust approach to developing your PCN.

This work can be completed on a fixed fee (price on application tailored to your circumstances).

PCN survey report & recommendations

We recently carried out research with our GP Practices for their thoughts around Primary Care Networks - find out what they said and our recommendations by clicking here.

Further information

PCN Structures

Although NHS England released a standard document, it contains a lot of gaps which networks are expected to complete themselves - particularly when it comes to governance and financial provisions.

We are currently advising PCNs across the country on what structure to use to establish their networks, and on the governance and financial provisions that should be included in their network agreements. Most practices recognise that, for example, it is risky to sign network agreements if the decision-making provisions do not reflect the needs of their particular PCN - and any practice acting as a lead practice in engaging staff will want some reassurance that its financial liabilities are backed off properly in the network agreement. We are happy to help practices with this.
Network Agreement Support

A mandated standard form Network Agreement has been issued by NHS England, and practices will need to sign this by 30 June if they want to ensure that the initial £1.76 per patient is backdated to 1 April. The template Network Agreement works well as far as it goes, but key sections have been left blank for networks to fill in, including schedules dealing with governance and decision making, and also financial issues.

It is very important, particularly for lead practices, that the financial provisions are completed, to ensure that the other practices contribute if the lead practices incurs additional costs as a result of its role.

As with any form of joint working, ensuring that the intended working arrangements are accurately reflected in the governance documentation is key to avoiding disputes and ensuring the parties understand the basis upon which they are working.

PCN Timeline

Date	Action
Jan-Apr 2019	Practices meet to discuss forming PCNs and begin to put together the Network registration requirements
By 29 Mar 2019	NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network DES Specification
By 15 April 2019	Primary Care Networks submit registration information to their CCG
July 2019	Network DES, the new GP practice contract, goes live across England
July 2019	Agreements with other community organisations are concluded
July 2019	Key appointments are made and additional funding alerts
By April 2020	Clinical pharmacists and social prescribers are appointed in PCNs
By April 2021	First Contact Physiotherapists are available in PCNs and Primary Care training hubs are set up
By April 2022	Increased focus on heart and lung disease prevention, and Community Paramedics join PCNs

Download our latest PCN information sheet.

For specialist legal support setting up a Primary Care Network, please contact, Oliver Pool on 0117 314 5429 or make an enquiry below.

I would like to say we have been delighted with the service you have offered. You have always been very approachable, both by email and phone, with prompt replies that are written in plain English that even a doctor can understand!

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Primary Care Law Advice for GPs

Ben Willis

Oliver Pool

Rachel Crean

Primary care networks - Frequently Asked Questions

Setting up a Primary Care Network (PCN)

Frequently Asked Questions

How we can help

PCN survey report & recommendations

Further information

PCN Timeline

For specialist legal support setting up a Primary Care Network, please contact, Oliver Pool on 0117 314 5429 or make an enquiry below.

Get in touch

News & Events

Primary care networks

Primary Care Law Advice for GPs

Ben Willis

Oliver Pool

Rachel Crean

Primary care networks - Frequently Asked Questions

Setting up a Primary Care Network (PCN)

Frequently Asked Questions

How we can help

PCN survey report & recommendations

Further information

PCN Timeline

For specialist legal support setting up a Primary Care Network, please contact, Oliver Pool on 0117 314 5429 or make an enquiry below.

Get in touch

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