Primary Care Networks and what this means for GPs
A five-year framework for General Practice (GP) contract reform has just been released. The pressing question is whether it will solve some of the notable problems faced, such as how to navigate the provisions that require GPs to become part of Primary Care Networks (PCNs). The funding boost is tied to this, but how PCNs will be formed remains the work of GPs. What are the various options that GPS can consider in the future?
Primary care networks – creation and implementation
The latest version of the National Health Service Employers (NHSE) operating plan provides Clinical Commissioning Groups (CCGs) to encourage every practice in England to bepart of a local primary care network aiming to cover the whole country by the end of 2019. PCN will be based on GP registered lists, typically serving natural communities of around 30,000 to 50,000.
NHS England has said individual GP practices will enter into a network contract as an extension of their current contract.The network contracts will have a designated fund and will be part of the new multi-year GP contract agreement currently being negotiated between NHS England and the British Medical Association (BMA). According to the long-term plan, enhanced service contracts commissioned by clinical commissioning groups will also be added to the new network contract.
GPs will need to consider how best to form a PCN locally andthe legal implications of a network contract, any legal agreements that would need to be in place for practices to meet the requirements of the contract (including the mandated Network Agreement) and the governance arrangements that will need to be in place as a result.
Super-partnerships – creation and implementation
Super-partnership are a possible solution for GPs wishing to work at scale but to protect the partnership model. Super-partnerships offer a shared administrative and managementstructure, cutting down the time doctors have to spend on admin. Other benefits include economies of scale to get the best value from budgets, resources to develop innovative services, effective partnerships with local hospitals and careservices, and it can access new funding streams that are only available to large GP organisations.
GPs will need assistance to do the preparatory work to create the right conditions for the adoption of a super-partnership model, research the financial consequences andgain further advice on the correct legal structures for implementation. Advice on governance and how best to embed this to allow the new organisation to function as efficiently as possible will also be essential.
Vertical Integration and dealing with NHS trusts
In various parts of the country, NHS trusts are using an integration model (which is termed vertical integration by the Royal Wolverhampton NHS Trust) to provide a solution around sustainability for GPs who might be experiencing difficulty. GPs considering this route, which is likely to be used increasingly to solve a pressing problem, need to be advised in detail about the implications and to ensure they obtain the correct benefit from any such process.
Further information is required on the strategy that a partnership should use when dealing with a trust in these circumstances in addition to what the legal implications are.Partners will end up as employees of the trust and will need advice to ensure they obtain the correct financial benefit forthe transaction and any subsequent employment issues for partners or their staff. PCNs may also need to deal with other NHS organisations in collaboration to form an Integrated Care Provider (ICP) solution. This will likely be governed by a new form of contract, the NHSE has released the draft version of an ICP Contract.
Advice on property development and access to capital for PCN sites
Now that PCNs are the accepted way forward there may be opportunities for GPs to invest in new buildings and thereby ensure they have a capital interest in their future development. The limitation of the prohibition on transfer ofgoodwill around the transfer of a General Medial Service (GMS) means that the only business investment GPs can do is through property.
PCNs could provide an impetus for a new phase of property development to create new purpose-built PCN centres. This may be an attractive opportunity for a new generation of GPpartners. There is also the issue of what to do with existing practice properties as PCNs coalesce as certain practice premises will be surplus to requirement.
PCNs appear to be the way forward for the next development phase of GP. However, much work needs to bedone when considering this and almost all of it will be left toGPs themselves. They will need assistance to navigate through this change and transformation. Interim Partner’s Health & Social Care Practice has 15 years’ experience supporting NHS trusts and would welcome any discussions regarding this topic.