At the heart of the NHS Long Term Plan is the principle that prevention is better than cure; and when illness cannot be prevented, it should (where clinically appropriate) be treated in primary and community care. Integrated primary and community care, and personalised care, are at the forefront of the Plan – and primary care networks will have a key role in achieving the Plan's aims.
CCGs to ensure all practices are part of a Primary Care Network
The Plan, and NHS England's Operational Planning and Contracting Guidance 2019/20, confirm continued investment and commitment to integrated primary and community care, including primary care networks. CCGs must ensure that all GP practices are members of a primary care network by 30 June 2019 at the latest and must commit a recurrent £1.50 per head to developing and maintaining primary care networks. The target is "100% coverage as soon as possible and by 30 June 2019 at the latest".
Primary care networks are based on GP registered lists, typically serving local communities of around 30,000 to 50,000. They comprise multidisciplinary teams such as physiotherapists, dementia workers, pharmacists and district nurses. Networks should be small enough to provide personalised care, but large enough to benefit from economies of scale, through better collaboration between GP practices and community care providers.
A good example of the focus for primary care networks is in care homes. The Plan commits to upgrading NHS support to all care home residents by 2023/24. Residents will benefit from pharmacist-led medicine reviews where required. Primary care networks will work with emergency services to provide out of hours support. Care home staff will have access to NHSmail to enable them to communicate with local NHS teams who are involved in residents' care.
How will this work in practice?
- The BMA is currently negotiating changes to GP contracts which will mandate practices to join networks. Importantly, GP practices will not be asked to give up GMS/PMS contracts. The network agreements will be separate to the provision of core primary care.
- There will be a designated single fund through which all network funding will flow and a single network contract with the CCG. It is likely that each network will appoint a single legal entity to receive the funding. All local enhanced services are likely to be funded by CCGs through the networks. It is not yet clear what contractual arrangements will be in place between CCGs and a network – this might be a formal contract or simply an extension to existing local enhanced services contracts.
- Changes to incentives – there will be a revised GP Quality and Outcomes Framework (QOF) to include a new Quality Improvement element that will focus more on personalised care. Networks will be offered shared-savings schemes if they achieve key indicators, such as reduced avoidable A&E attendances.
- Practices within a network will need a separate agreement between themselves to decide how the funding will be shared, the objectives of the network, and how the practices will work together to achieve the outcomes in the CCG network contract.
- There is no specified organisational form for primary care networks, however, where multidisciplinary teams are being created, and patient data is being shared across organisational boundaries, it is important that there are robust contractual arrangements in place to ensure legal compliance, proper governance and accountability.
How will networks integrate with the rest of the local health system?
Sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) must include a primary care strategy, as part of their overarching strategy to improve population health. These will include a specific primary care network development plan.
STPs/ICSs must ensure that primary care networks are provided with primary care data for population segmentation and risk stratification, complemented with local requirements, to allow networks to understand their populations’ needs for symptomatic and prevention programmes including screening and immunisation services.
Where an ICS has an integrated care provider (ICP), it could use NHS England's template integration agreement to agree with primary care network members how they will provide services across the ICS in a collaborative way.
Given many areas across the country have set up GP federations or operate a “Primary Care Home” model, it is not entirely clear what the interplay might be between those existing collaborations and the latest plans to create primary care networks. It would seem sensible for there to be some flexibility as to what constitutes a “network” particularly given that networks (rather than GP federations) are noted as being represented as part of ICS governance. CCGs will not wish to see tiers of bureaucracy created within their primary care provider landscape where it can be avoided, particularly where their primary care providers are already collaborating for the benefit of the local health system.
Our view
The integration of primary and community care providers is essential to enable the NHS to meet the goals it describes and is rightly a priority. Primary care networks build on the core of current primary care services and enable greater provision of personalised and integrated health and social care. Evidence from case studies suggests that when practices operate within primary care networks, there is usually a shift from reactively providing appointments to proactively caring for people within their communities.
To ensure this works, communication and planning are essential. CCGs will need to ensure that GP practices are collaborating now to enable the planning and development of networks. Practices will need to agree clearly defined roles, and put in place robust arrangements, so that the CCG network contract outcomes can be met.
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