Good news or bad?

The new GP Contract Framework has been released and this will form the basis of a new contract for the next five years for GP services. It has been agreed by NHSE and the BMA and will apply for the contract year 2019/20.

The new contract has the following goals:

1. Address workload issues resulting from workforce shortfall.
2. Bring a permanent solution to indemnity costs and coverage.
3. Improve the Quality and Outcomes Framework (QOF).
4. Introduce automatic entitlement to a new Primary Care Network Contract.
5. Help join-up urgent care services.
6. Enable practices and patients to benefit from digital technologies.
7. Deliver new services to achieve NHS Long Term Plan commitments.
8. Give five-year funding clarity and certainty for practices.
9. Test future contract changes prior to introduction.

Significant funding is promised within the terms of the framework to achieve the goals and this will create a lot of interest at practice level. The clear mandate to create Primary Care Networks (‘PCN’) will be a significant change for General Practice and could be truly transformative. However not all of the details are clear and the process must be completed by May 2019. This will not be an easy as the level of awareness in practices will vary dramatically and the diktat is clear – the funding only flows if all practices in a PCN are members.

The introduction of Primary Care Networks is a clear attempt to begin the process of ensuring General Practice works ‘at scale’ and a new Network Contract DES is being introduce to provide ‘impetus’. As a DES, it will be an extension of the core GP contract, not a separate contract. The commissioner of the Network Contract DES will likely be the CCG in nearly all instances.

Timing is tight – GPC England and NHS England are committed to 100% geographical coverage of the Network Contract DES by Monday 1 July 2019 as a ‘go live’ date.

Date	Action
Jan 2019	PCNs prepare to meet the Network Contract DES registration requirements
Mar 2019	NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network Contract DES
May 2019	All Primary Care Networks submit registration information to their CCG
May 2019	CCGs confirm network coverage and approve variation to GMS, PMS and APMS contracts
Jun 2019	NHS England and GPC England jointly work with CCGs and LMCs to resolve any issues
Jul 2019	Network Contract DES goes live across 100% of the country
Jul 2019 / Mar 2020	National entitlements under the 2019/20 Network Contract start: year 1 of the additional workforce reimbursement scheme ongoing support funding for the Clinical Director, ongoing £1.50/head from CCG allocations
Apr 2020	National Network Services start under the 2020/21 Network Contract DES

To be eligible for the Network Contract DES, a Primary Care Network needs to submit a completed registration form to its CCG by no later than 15 May 2019, and have all member practices signed-up to the DES. It asks for six factual pieces of information:

1. the names and the ODS codes of the member practices;
2. the Network list size, i.e. the sum of its member practices’ registered lists as of 1 January 2019;
3. a map clearly marking the agreed Network area;
4. the initial Network Agreement signed by all member practices;
5. the single practice or provider that will receive funding on behalf of the PCN; and
6. the named accountable Clinical Director.

Clearly there are a number of steps which many practices will not be prepared for; the requirement of a ‘Network Agreement’ is important and, as yet, NHSE has not produced a draft.

Formation is also an important consideration. NHSE is clear that this is not an invitation to GPs to ‘team up with their mates’. List size is expressed as ‘at least’ 30,000 people (although it is not clear if this is registered patients) and a PCN should not extend over 50,000. The PCN must make geographic sense to:

(a) its constituent practices;

(b) to other community-based providers, who configure their teams accordingly; and

(c) to its local community.

Interestingly the patients of a practice that does not want to join a PCN must be included in a PCN and all payments will still flow to the PCN lead.

Funding in year 1 will consist of:

• 0.25 FTE per 50,000 of population for the Clinical Director;
• £1.50 per registered patient. This payment is a recurrent extension of the existing £1.50 per head support scheme, which was set out in the December 2018 NHS planning guidance;
• NHSE will establish a new development programme for PCNs; and
• CCGs can provide support in kind.