The focus on access in this year’s contract mean that the relationship between PCNs and their member practices need to change.  The PCN leadership needs to take on a much more supportive role while practices must become more active in shaping the work of the PCN.

Things are different this year.  Despite the government’s claims that it has simply imposed year 5 of the existing contract, the reality is it hasn’t.  They took legislation through parliament to be able to change the core GP contract, which placed a new requirement on practices to respond to contacts made by patients on the day the contact is made (full details here).

What has then happened is that PCN funding has been used to support the change.  The IIF has largely been scrapped, being reduced to just five indicators worth £59 million, with the remaining IIF-committed funding of £246m for 2023/24 now becoming a Capacity and Access Payment.

‘National Capacity and Access Support Payment: 70% of funding (£172.2m) will be unconditionally paid to PCNs, proportionally to their Adjusted Population, in 12 equal payments over the 2023/24 financial year’ (PCN DES).

This is not really unconditional money.  It is money to enable practices to make the changes they need to become compliant with the new terms of the contract (without that ever having explicitly been said).

There are some explicit overlaps, e.g. the contractual requirement for practices to use digital telephony and its inclusion within the PCN access improvement plan.  Indeed, the PCN plan has to, “set out the current position across the PCN, by each practice in the PCN, according to the table below” according to the NHSE guidance.  The capacity and access work of the PCN is (intentionally) inextricably linked to the introduction of the imposed contract changes on individual practices.

The payment of the remainder of the IIF money, i.e. the other 30% of the national capacity and access support payment, is based on the PCN demonstrating improvements made by its practices in this area, e.g. have all the practices scheduled a date to shift to digital telephony, are all the practices accurately recording appointments.

This represents a pretty fundamental shift.  In the past the dynamic between PCNs and practices was essentially one where the PCN led the delivery of work, and this work was supported by the member practices.  For example the PCN had to ensure that all the care homes were receiving regular ward rounds, and each of the practices had to play their part.  Or the PCN had to ensure the IIF indicators were being delivered and each practice had to play its part.  But each time the responsibility lay with the PCN, and the practices had very much a support role.

This feels different.  For one thing, how on the day demand is managed during core hours is very much core contractual work for practices, which up until now had very much been none-of-the-PCN’s-business.  All of a sudden how practices are run has become of mutual concern.  And the funding to enable practices to deliver their (albeit new) contractual requirements is being given to the PCN (via the capacity and access payment), when previously core contractual funding had always come directly to the practices.

For this work, it is hard to see how the common PCN-led, practice-supported model of delivery is going to be effective.  PCNs can’t for example be telling practices how to run their on the day demand, or demanding project plans from each of their practices.

Instead the PCN delivery model needs to change, and become one that is more practice-led and PCN-supported.  There can be rich learning across practices within a PCN as to how they do things and what works and what does not.  There can be mutual support from practices who have introduced digital telephony sharing the opportunities and pitfalls with those doing it for the first time.  There can be practice-led conversations as to how ARRS staff need to be deployed to enable the right range of care navigation opportunities for them to be able to meet their contractual responsibilities, which the PCN can support.

This year’s changes mean the relationship between PCNs and practices needs to evolve, with the PCN leadership taking on a much more supportive and enabling role, creating a sharing and learning environment, while practices become much more active in designing and shaping the specific changes that need to be made.