So the dust has settled and according to NHSE (who will be giving themselves a huge pat on the back) 99.5% of you have joined a PCN. By the way that means you have signed a legally binding document but let’s come back to that later. So you have done the hard bit and now you can sit back and relax and all the promised new funding (£4.5bn by the end of 2023/4) will flow in. Happy days.

Except…. Not quite the way its going to work. It sounds like a lot of money but given you are dealing with NHSE in its present frame of mind, there are strings attached. Quite big strings in fact. Ian Dodge, National Director of Strategy and Innovation has just released a paper entitled ‘Implementing the Long Term Plan in primary and community services’ and you should probably all have a read of it. It is 83 pages worth so you may well not have the time to do so but fear not as I have read it and here are some thoughts.

So let’s start with how the money flow works. I’m afraid it isn’t as simple as dividing the £4.5bn by the number of PCNs (which incidentally is quoted as 1259) and sending that amount on an annualised basis to you all. Rather it is all part of the creation of Integrated Care Systems and actually it does make sense to tie the extra money into a system-driven approach. Primary care will have more moving parts than just General Practice and GPs are probably not unhappy about that because they won’t want to do all the extra work that is being planned themselves. So going forward, the extra money will form part of the minimum spending requirement (a) at the level of every ICS in 2023/24, and (b) at the level of every region from 20/21. Supposedly this will avoid unrealistic backloading, whilst giving regions some flexibility in the three years between 2020/21 and 2022/23. Every region will operate the guarantee for April 2020 onwards. To meet its required share of the regional guarantee from April 2020, each CCG and STP/ICS will need to:

(i) fully honour 100% of the GP contract entitlements each year; plus
(ii) spend at least their agreed share of the remaining cash amount of the
guarantee each year.

This amount will include the baseline of pre-existing 2018/19 planned spending levels on primary care, community health and CHC services. All CCGs – even those with the lowest growth – have been funded in allocations to deliver their share of this guarantee.

So all this means that you are going to be tied into the system, like it or not. The payment would still appear to be in the hands of the CCGs as well but what latitude they will have to pay or not remains to be seen. However it looks as if NHSE (via the CCGs) is not ready to give up ‘control’ yet: ‘Some have suggested that PCNs might assume CCG statutory functions, such
as population need assessment, or can be the reincarnation of the GP multifund or Total Purchasing Pilots. This is neither our intention nor legally possible. The primary care network is not about commissioning. Instead, PCNs are about collaborative provision.‘ Note the bolded text (which is actually in the document). I’m afraid that you won’t get to decide how to spend the money therefore. However opportunity might still come knocking because a load of new services (especially the community services) may well be up for grabs and PCNs (or clusters of them) could bid for these. More of this in a later article about business opportunities.

NHSE has set some pretty lofty ambitions for itself on the back of the PCN ‘revolution’, namely:

(i) they will have stabilised the GP partnership model;
(ii) helped solve the capacity gap and improved skill-mix by growing the
wider workforce by over 20,000 wholly additional staff;
(iii) become a proven platform for further local NHS investment,
including in premises;
(iv) dissolved the divide between primary and community care services; and
(v) having done (i) to (iv) first, achieved clear quantified impact for
patients and the wider NHS.

So are you convinced? Hmmm…. Me neither. Loads more work to be done before NHSE can continue the pat on the back exercise and declare ‘mission accomplished’.