Digesting NHS England’s consultation on the proposed Multi-Neighbourhood Provider (MNP) and Single Neighbourhood Provider (SNP) contracting models is not that easy. But the upshot for PCNs and GP Federations is that they are likely to become more important than ever.
Essentially the consultation is proposing a move in how funding flows through the system to practices. In the current model, somewhere in the region of 30% of a typical practice income will come to the practice via the PCN DES and local enhanced services. While some of this goes to the PCN, much still flows direct to the practice – in particular local enhanced service funding.
The proposed model in the consultation is that all of this income, the PCN DES and local enhanced service funding, is combined into the new Single Neighbourhood Provider (SNP) contract. This funding will be locally not nationally determined, although there are certain safeguards proposed to protect the existing PCN funding levels.
This funding will not come direct to practices, but come via the PCN. PCNs will have to develop as entities as they take on these contracts. The document states that “the holder of the SNP Contract must be a legal entity, although, for example, it could be held by a lead practice on behalf of a consortium of practices”. The requirements for infrastructure to deliver against these contracts will only increase from what PCNs currently have in place.
So in future the percentage of practice funding coming through the PCN is going to go up, and represent something in the region of a third of total practice income. It is not hard to imagine a scenario developing in future where this percentage goes up further still – the direction of travel appears pretty clear.
Practice to PCN relationships have been important, if sometimes strained, over the last seven years. The proposed changes mean this is likely to be even more the case going forward.
The consultation suggests ICBs may hold these SNP contracts directly with PCNs. But it also suggests that they could be held either by the local foundation trust if/when it becomes an IHO, or by a new MNP.
MNPs are to operate over a place-based area, with 250,000 given as the guideline population. While it seems highly unlikely individual PCNs will be able to take on MNP contracts, PCNs working together as a group, or GP federations operating in the area, seem ideally placed. The need for strong relationships between MNPs and SNP contract holders seems to put them into pole position.
This does not mean taking this opportunity will be easy. PCN to PCN relationships are pretty fractious in many places, and GP federations don’t exist everywhere and themselves often have challenges with PCN to federation relationships. Local areas will need to work this out quickly, because the absence of any effective at-scale general practice will create a vacuum that community trusts and others will be keen to jump into.
The upshot of all of this is that PCNs, GP federations and at-scale general practice are suddenly more important than ever, because these new contracts mean that they are going to be key to general practice retaining its independence, shaping how neighbourhood health develops and enabling the service to thrive into the future.
