It has been very hard to think of anything other than covid for the last 6 or so weeks, but it feels like we are now just reaching the point where we can start to consider where other issues are up to.  In particular, PCNs were a controversial topic in the first three months of the year, and the deadline for signing up to the 20/21 DES is fast approaching.  So where did things with PCNs get to?  Time for a recap.

The 20/21 PCN DES got off to a bad start when the draft specifications were published just before Christmas.  What followed was widespread uproar over the level of specificity they contained, the financial implications for practices, and the lack of any additional funding to go with the new workload requirements.

These were only drafts for consultation, and following a torrent of negative feedback the GPC and NHS England commenced negotiations on the new contract.  The result was a reduction in both the volume and specificity of the service specifications (leaving only three: structured medication reviews and medicines optimisation; enhanced health in care homes; and supporting early cancer diagnosis), a commitment to fully fund the new roles (as opposed to providing 70% funding), and additional funding for the care home specification.

What followed this agreement between the GPC and NHS England was a general calming down, and a sense that what was on offer was much more reasonable.  However, underlying concerns about what PCNs mean for the independent contractor model persisted.  These culminated in a vote at the special conference of England LMCs on the 11^th March, which decided to reject the agreed DES specification.

Before anyone really had a chance to react to this, covid happened.  Indeed it was only 8 days later that NHS England published a letter detailing further changes to the PCN DES.  These changes were designed to do two things: push the work back until after covid (the start date for the new specifications were essentially all moved to 1^st October); and use the PCN DES to release money into general practice to support with the crisis.  The new Investment and impact fund was replaced for its first 6 months with a PCN support payment of 27p per weighted population (not contingent on performance), and the funding for all the new roles (PCNs now have an additional role reimbursement scheme (ARRS) allowance from which they can fund any of 10 new roles) was made available despite the specifications not starting until October.  Indeed all the PCN DES funding has been made available to practices who sign up from April.

These changes were confirmed in the covering letter for the final PCN DES specification which was published on 31 March.  NHS England has been clear that they made sure this came out not because of a stubborn commitment to PCNs, but to ensure that money continued to flow to PCNs in the midst of the pandemic.

So the PCN DES specification is out.  Practices have until 31 May to decide if they want to participate.  Sign up is easy, especially if the PCN is not changing its membership.  Practices simply confirm their ongoing participation to the commissioner.  Once signed up practices remain signed up for the year, and cannot withdraw during the course of the year.

There have been some concerns that by signing up for this year practices are committed for a longer period.  That is not the case.  The system does change to one of opt-out rather than opt-in from April 2021, but the process of opt-out is straightforward.  The practice must simply, “notify the commissioner within one calendar month of the publication by NHS England and NHS Improvement of the specification for the subsequent Network Contract DES” (Network Contract DES Specification 4.13.1).

The GPC are encouraging sign up, as are many LMCs (e.g. Surrey and Sussex).  The rationale is it represents a vehicle to channel funding into general practice in the national effort to deal with the pandemic, and it continues to enable a structure for much needed collaboration between practices to enhance support and resilience for practices at local level.  Other LMCs (e.g. Berkshire, Buckinghamshire and Oxfordshire) remain fundamentally opposed and so are taking a more neutral stance and neither recommending practices sign up or don’t sign up.

So this is where we are.  My 10 cents for what it is worth is that with all the uncertainty that covid brings for the next 12 months this isn’t the time to be walking away.  The PCN DES brings significant funding and resources into general practice over the whole year, while the additional work is only for 6 months (and that is assuming we don’t have any future covid disruption).  Even if you are not sure about PCNs it is not difficult to opt out next year, so you are not making a lifelong commitment.  Covid has changed everything, and the PCN DES is no exception.