I am not sure how many of you will have read by now the “Update to the GP Contract Agreement 2020/21 – 2023/24” released by the BMA and NHS England last week, but having waded through all 86 pages it is hard to take it all in. There are huge implications in particular for PCNs, who will need to digest the contents quickly to be able to move to action.

First things first. It looks like the big problems caused by the draft PCN DES specifications have been addressed. The biggest sticking point was no extra money to deliver the required extra work, followed by the seeming requirement that all of the additional roles would be used to deliver extra work and not support core general practice, with practices expected to chip in 30% of the funding for the privilege. The draft specifications were also seen as over-prescriptive, stifling local innovation and responsiveness.

This update addresses these issues in some surprising ways. The number of specifications needed to be delivered in year has been reduced from 5 to 3. Only structured medication reviews, enhanced health in care homes, and supporting early cancer diagnosis remain, with the other four to follow next year (two were always planned to be implemented from 2021). PCNs are also to “provide access to a social prescribing service in 2020/21, drawing on the workforce funded under the network contract DES” (7.5, p41).

100% reimbursement is to be provided for the new roles, removing the need for a 30% contribution from member practices/the £1.50 per head. This won’t solve the problem of being able to recruit into the roles at the funding levels available, but it tackles the major issue of sourcing the 30%. 6 new roles have also been added to the list that PCNs can use this funding to recruit from: pharmacy technicians; care coordinators; health coaches; dietitians; podiatrists and occupational therapists.

Importantly, assurances are made that the funding for these roles will continue in the core GP contract beyond 2023/24, and that should practices withdraw from the PCN DES the roles would TUPE to whichever provider takes over the delivery, alleviating concerns about future liability costs.

Access to further funding is also provided for PCNs. The level of funding available to source these new roles has been increased. Where it was, for an “average PCN”, £206k in 2020/21 it will now be £344k. An additional (recurrent) £120 per care home bed per year will be directly provided.

PCNs can also access funds through the Investment and Impact Fund (IIF). This looks like it is essentially a QOF for PCNs. It is a points based system, with a number of areas each with indicators allocated a certain number of points. There are upper and lower thresholds beyond which no payment is made, with a sliding scale rewarding performance in between.

The “average PCN” can earn £32,400 in 2020/21 from the IIF (although it has to declare it will use any funds earned for workforce expansion and services in primary care). This will rise to £240,000 per PCN by 2023/24. There are 8 indicators for 2020/2021 for seasonal flu vaccinations, LD health checks, referrals to social prescribing, gastro-protective prescribing (3 indicators), metered dose inhaler prescriptions, and spend on medicines that should be routinely prescribed.

The challenge, then, for the PCN is first of all to identify its overall delivery requirements for next year (delivery against the specifications, delivery of a social prescribing service, delivery against the IIF indicators, and any agreed local delivery).

Then the PCN in relatively short order has to establish the additional roles it will need to enable this delivery. PCNs are required to produce (and submit) their workforce “intentions” by 30th June at the latest, but will most likely need to be actively recruiting well ahead of this. The document encourages, in light of the additional role reimbursement funding, PCNs to use the (existing, recurrent) £1.50 to appoint a full time manager and increase PCN Clinical Director time so that the growing PCN workload can be managed effectively. Sounds sensible.

It does seem that there are sufficient resources available in the updated contract to meet the requirements it makes, while at the same time leaving some freedom for local developments, delivery and innovation. This was always the key for me as to whether the revised proposals would make sense.

There is of course more in the update that I haven’t touched on. There is a renewed focus on increasing the number of doctors, with initiatives including a new two year fellowship programme for all newly qualified GPs and nurses, a new to partnership one off payment of £20,000 to encourage GPs to become partners, and a locum support scheme to encourage consistent locum working with groups of PCNs.

We may have a new government but access inevitably features. This year all practices will be required to participate in an appointments dataset, and then it is about preparation for April 2021, by when there will be a “nationally consistent” offer developed for bringing extended hours and extended access funding together, as well as a core digital service to be offered to all patients.

A new payment mechanism for vaccinations and immunisations is being introduced over the next two years. This year it will become an essential service with new contractual core standards that practices will be expected to meet, and an item of service payment of £10.06 introduced for MMR 1 and 2. In year 2 the item of service payment will be expanded to other areas, and a new QOF domain for routine vaccinations will be introduced, with the existing childhood immunisation DES retired.

There are, as ever, a few adjustments to QOF, but that is the bones of the changes within the updated contract agreement. I am sure it will take time to take it all in (especially getting our heads round the new investment and impact fund!), but from first impressions it seems that PCNs may well survive the turbulence of the last few months and be able to build a platform from which they can start to make a real difference.