Whilst we are already a couple of months into the new financial year, with so much going on it has been hard for everyone to fully get their heads round the changes to the Impact and Investment Fund (IIF) for 2021/22. This week I summarise those changes and what it means for PCNs and practices.
I wrote last year about the Impact and Investment Fund when it was first introduced. You will recall for the first six months of last year the funding was protected as a covid fund for PCNs. The IIF was then launched in October, in the format of a ‘QOF for PCNs’.
PCNs are yet to receive money earned from the IIF for the last six months of 2020/21. As I understand it once the figures have been collated nationally, and they have established exactly what an “average” PCN comprises of, PCNs will be sent a draft declaration which they will need to confirm as accurate, or appeal to their commissioner if the figures are wrong. The amount of time it is taking to pull these figures together suggests there may be trouble ahead in getting final agreement on these figures!
Year 2 of the IIF is nonetheless underway. The scheme works the same way as last year, with minimal changes. The prescribing indicators have been dropped (I suspect at least in part to do with the challenges of integrating the prescribing database with the information from GP systems). This year there are three flu vaccination indicators, the social prescribing and annual LD health check indicators remain (with adjusted thresholds), and there is a new one off indicator of “mapping appointment categories to new national categories” which needs to be completed by the 30th June.
There is £200 available per point (adjusted for list size and prevalence), with 225 points available in total. The indicators and amounts available for an “average” PCN are below (also see the PCN DES specification Annex D, p103):
| Indicator | No. of points | Upper Limit | Lower Limit | £ available |
| % patients aged 65+ who received a seasonal influenza vaccination 01/09-31/03 | 40 | 86% | 80% | £8,000 |
| % patients aged 18-64 and in a clinical at-risk group who received a seasonal influenza vaccination 01/09-31/03 | 88 | 90% | 57% | £17,600 |
| % children aged 2 – 3 who received a seasonal influenza vaccination 01/09-31/03 | 14 | 82% | 45% | £2,800 |
| Percentage of patients on the Learning Disability register aged 14+, who received an annual Learning Disability Health Check and have a completed Health Action Plan | 36 | 80% | 49% | £7,200 |
| % patients referred to social prescribing | 20 | 1.2% | 0.8% | £4,000 |
| Confirmation that, by 30 June 2021, all practices in the PCN have mapped all active appointment slot types to the new set of national appointment categories, and are complying with the August 2020 guidance on recording of appointments | 27 | Binary target – all practices to achieve for PCN to receive in year payment | £5,400 | |
The amount available is roughly double what was available for the last six months of last year (£40,500, compared to £21,500 for an average PCN last year). A key point to note here is that only one third of the £150M set aside for the IIF in the contract for this year has currently been allocated. The plan is to allocate the rest of it to new indicators to be introduced from 1st October (Covid permitting) with double the value of the existing indicators. My understanding is these indicators are most likely to be linked to delivery of the new PCN specifications also due to be introduced at that time.
So by the end of the year the IIF is likely to be worth over £120k to the average PCN. This is due to increase further to £250k by 2023/24. During this year the IIF will overtake the core funding of £1.50 per head in terms of value to the PCN, and will continue to grow thereafter.
The flu indicators, representing 142 of the 225 points on offer, do not start until September, so at present there is relatively little for PCNs to do, other than to ensure they have effective monitoring and reporting systems in place, to try and get ahead of the social prescribing referral target, and to ensure all practices carry out the appointment mapping exercise.
But this will most likely be the calm before the storm. The importance of the IIF may be minimal at present, but the values attached to it mean this is likely to change significantly in the second half of the year. At that point the new indicators alongside the existing flu ones will mean the work really begins.
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