The revised PCN DES was published on 30^th March, 2 days before it was due to go live.  What are we make of the changes that have been made?

The first thing to say is that the PCN DES cannot be understood in isolation from a number of other documents.  The first, and probably most important, is the updated GP contract.  This still has not been published (as of the 3^rd April), but what we do know about it is that it has been imposed (i.e. not agreed by the BMA) and the funding contained within it has been increased at the rate agreed in 2019, i.e. below 3% while the cost of living remains at over 10%.

Bear in mind then that the additional funding coming into general practice is only coming via the PCN DES, hence its importance, particularly its financial importance, is greater than ever.

NHS England published a letter outlining the main changes to the GP contract.  The letter also points to a ‘Plan for Recovering Access to Primary Care’.  It states, ‘The Chancellor in his Autumn Statement set out a commitment to publish a recovery plan for General Practice access in early 2023. The Delivery Plan for Recovering Access to Primary Care will be published shortly and sets out how practices and PCNs can be supported to improve access during 2023/24’.

This letter was published on the 6^th March, and yet here we are 4 weeks later with nothing out yet.  But it is safe to say that improving perceived access to general practice remains the number one political, and hence NHS England, goal.

This then frames the ‘big news’ in the PCN DES, which is the reduction in the size of the IIF 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.

However, the detail within this means it is not as bad as it might sound on the surface.

PCNs will basically receive 70% of this capacity and access payment just for participating (very roughly £140k per PCN for the year):

‘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’  

All PCNs seem to have to do for this is develop an access improvement plan that is agreed with the ICB by 12 May.

The other 30% will be paid based on improvements made in three areas: patient experience of contact; ease of access and demand management (use of cloud based telephony and online consultations); and accuracy of recording in appointment books:

‘Local Capacity and Access Improvement Payment: part or all of 30% of the funding (£73.8m) will be paid to PCNs based on commissioner assessment of a PCN’s improvement in three areas over the course of 2023/24.’

What is really interesting about all of this is that none of these payments are based on how long patients actually have to wait for an appointment.  Now, the IIF contains a single indicator (of the 5 that remain) that actually does measure waiting times (ACC-08: Percentage of appointments where time from booking to appointment was two weeks or less).

But this IIF indicator (the only one with actual measure of waiting time) is worth 71 out of the 262 points available, and worth £14,058 for the year to an average PCN (out of £51,876 for the IIF as a whole).

So, just to break the finances down, PCNs will receive c£140k for participating in the capacity and access scheme, and could receive up to c£60k for improvements in the three areas above, with no measure of actual reduced waiting time.  But they can only earn £14k for achieving the IIF target of patients seen within 2 weeks (the only actual waiting time measure).  And of course the IIF targets are voluntary.

This is why the GP contract itself is more important here than the PCN DES.  PCNs can earn virtually all of the money available without changing how long it takes for a patient to get an appointment.  We just need to make sure there are no horrors hidden away in the main contract when it is published.

There is a hint of what may be to come with the local capacity and access improvement payment being based on “commissioner assessment” of improvements made.  We saw from the Fuller report the desire to put more of GP funding within the control of the Integrated Care Boards, and this does seem to signal a step (albeit small) in that direction.  For example, it means the chances of a consistent approach to what constitutes local ‘improvement’ across the country is zero.

The changes outlined here also does set general practice up for potential waiting time targets in the future, but I am not sure that is avoidable.  What we do have here is a relatively straightforward way for PCNs to earn the IIF funds, and one that is probably going to be easier than if there had been an extensive range of IIF targets instead.

Overall the PCN DES for this year is fine.  The PCN DES is where the extra money and resources are for general practice.  What is not fine is the GP contract for this year and the refusal of the government to fund the cost of living rise for practices and their staff.  What is important for general practice is not to confuse the issues, and end up losing the resources in the PCN DES because the core contract has not been properly funded.