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Setting Up Your Primary Care Network and Completing the Network Agreement

on Tuesday, 09 April 2019.

NHS England has now released the Network Contract DES, the mandated Network Agreement and associated guidance.

This means that primary care contractors can now move to progress the development of their Primary Care Network (PCN) governance arrangements into a more formal footing in readiness to register their PCN by the deadline of 15 May 2019.

Our recent input to the Family Doctor Association PCN Factsheet highlighted the steps that could be taken by contractors while waiting for the documentation and much of this is still relevant. Identifying your PCN's objectives and delivery model will then enable the PCN to evaluate this against the main concerns noted below.

What Does a PCN Look Like?

There is no doubt the PCN itself is underpinned by a contractual collaboration, as opposed to a corporate entity but as with MCPs and PACs, the delivery model may differ between localities and the mantra of "form follows function" remains as pertinent as ever. PCNs can include corporate primary medical service providers as members and looking outside the Network Agreement itself, we might expect to see a range of other providers and stakeholders working with PCNs under separate contractual arrangements to fulfil the local delivery model. This may include setting up new corporate structures.

It should be noted that 2019/20 is the first year for PCNs and it is expected to evolve over the coming years to take on additional services and potentially incorporate non-primary care contractors. It will be important to keep abreast of the changes and ensure that the arrangements are adapted and kept up to date as these changes are brought through.

What Does the Network Agreement Say and What Doesn’t It Say?

The Network Agreement sets out the core elements of the collaboration between the parties as well as the minimum collaboration requirements that NHS England require in delivering the Network Contract DES. Whilst it deals with important general collaboration issues such as leaving and joining a PCN as well as other standard contractual provisions, it is structured as a template and the bulk of the detail of the arrangement is to be populated by practices within the schedules provided. These include but are not limited to:

  • decision making
  • the activities of individual member practices
  • financial arrangements
  • workforce arrangements
  • arrangements with third parties

Consequently, the Network Agreement can be adapted to reflect the particular delivery model of each PCN.

Immediate Concerns and VWV Support

Inevitably, when sharing services and staff, the mains concerns will be around the availability of the NHS pension scheme and potential VAT issues, but these are not the only areas which require careful thought. There are a range of other considerations including: sharing data, subcontracting, apportioning liability and documenting any premises solution.

We work closely with specialist medical accountants and PCN support services to help fledgling PCNs develop their model and their governance arrangements as well as with continuing support. We provide a service tailored to the needs and current progression of your PCN and are offering PCN development workshops to assist practices to develop their model.

We will shortly be issuing further articles on structuring your arrangements as well as employmentdata sharing and premises issues you need to be aware of.


If you would like to know more or require assistance with developing your Primary Care Network, please contact either Mark Jarvis on 020 7665 0880 or Adam Siwak on 020 7665 0963.

Customer Feedback (2)

  • Peter Woodley

    Peter Woodley

    11 April 2019 at 11:30 |
    A good and interesting article, obviously coming at it from the legal side. From the estates side, property and funding are critical to success. Restrictions on reimbursement rates and a lack of capital funding will prove a major headache if providers are going to come together to deliver transformation. Without this, and a long term strategic plan and estates strategy, it is questionable whether the system will deliver the overhaul required.

    To this end, CCG's and Local Authorities need to take the lead and look at the 20 to 30 year picture, the current health and social care estate, housing and population growth, demographic changes and subsequent demand on the system and prioritise investment.

    reply

    • VWV

      VWV

      15 April 2019 at 14:39 |
      Hi Peter,

      Thanks for your comment.

      Indeed, this can only be the first step on a longer journey and it is unfortunate that whilst noting PCNs should be the foundation of an integrated care system, the PCN scheme is being rushed into place ahead of any legislative change which could provide a more robust foundation on which to build. With respect to estates, the results of the NHS Premises review are expected soon and it is hoped that this and the expected new Premises Cost Directions will give greater clarity on how primary care premises will be funded and procured in the future.

      Kind regards,
      Mark

      reply

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