NHS England published a letter on the 21^st January, entitled “Supporting General Practice in 2021/22”.  The letter states NHS England and the GPC have agreed that, “too much remains unclear to confirm contractual arrangements for the whole of 2021/22”, and so the letter is intended to provide what certainty they can at this point given the pandemic.

The letter reinforces what we already knew, primarily that the majority of the additional investment into general practice is coming via the PCNs.  This primarily takes the shape of the Additional role Reimbursement Scheme (ARRS), where the total pot has been increased from £430M to £746M.

There are some interesting developments of the ARRS.  The most helpful is that those in London can now offer the same inner or outer London salary weighting as other NHS organisations (although they are still restricted to the same total pot).  Three new roles have been added: paramedics, mental health practitioners, and “advanced practitioners”.

PCNs have been looking forward to the opportunity to employ paramedics from April since it was announced last year that they would be able to do so.  There is a nasty sting in the tail in the guidance however,

“Where a PCN employs a paramedic to work in primary care under the Additional Roles Reimbursement Scheme, if the paramedic cannot demonstrate working at Level 7 capability in paramedic areas of practice or equivalent (such as advanced assessment diagnosis and treatment) the PCN must ensure that each paramedic is working as part of a rotational model with an Ambulance Trust” p7.

This theme of other NHS organisations bringing their weight to bear on the introduction of the PCN roles is also reflected in the new mental health practitioners.  Here there are even more complicated arrangements at play,

“From April 2021, every PCN will become entitled to a fully embedded FTE mental health practitioner, employed and provided by the PCN’s local provider of community mental health services, as locally agreed. 50% of the funding will be provided from the mental health provider, and 50% by the PCN (reimbursable via the ARRS), with the practitioner wholly deployed to the PCN. This entitlement will increase to 2 WTE in 2022/23 and 3 WTE by 2023/24, subject to a positive review of implementation.” p3.

Can the ARRS funding really be counted as funding for general practice if the funding is to be used for staff that are to be employed by the local community mental health provider?  It is a worrying precedent that has been set against the main source for investment into general practice.  It will be interesting to see how PCNs react to this, how keen they are to take up this offer, and what pressure is brought on them if they decline.

In better news the 4 outstanding PCN DES specifications will not be introduced at the start of 2021/22, with an implementation agreed once (if) the Covid situation scales down.  There is no mention of the existing 3 specifications and how they will be monitored through the year – something which varies considerably across the country.  The transfer of extended access will now take place in April 2022 (a more definite statement than the previous “from” April 2022), with the specification to be published this summer (i.e. September).

The Investment and Impact Fund (IIF) will continue.  The existing indicators of seasonal flu vaccinations, social prescribing referrals and LD health checks will continue (thresholds to be determined), which I assume means the prescribing indicators will not.

Finally QOF will remain broadly the same next year as this year.  A vaccination and immunisation domain will be added, adding £60m from the replaced childhood immunisations DES, there will be no new quality improvement modules but LD and supporting early cancer diagnosis will be repeated from this year, and £24M is being added to strengthen SMI physical health checks.

In summary then, no huge surprises, some minor disappointments, but on the whole a pragmatic approach to keeping the focus on the challenge that is front and centre right now of dealing with the pandemic.