Tara Humphrey
Apr 66 min
Updated: Apr 23
In this blog, we provide our initial take on:
A summary of the contract covering changes to the Additional Roles Reimbursement Scheme, deliverables, and funding streams.
9 potential next steps to help you move forward
An editable outline of a strategic plan that you can build on.
The advantages and disadvantages of the increased flexibility in the GP Contract 24/25.
On 28th February 2024, the Arrangement for the General Contract in 2024/25 was published.
The upcoming revised contract is designed to:
Cut bureaucracy for practices.
Help practices with cash flow and increase financial flexibility.
Give Primary Care Networks (PCNs) more staffing flexibility.
Support practices and PCNs to improve outcomes.
Improve patient access.
Grab your notebook, and let us jump in!
This contract will only be in place for 12 months and is referred to in this context as a stepping-stone contract due to financial restrictions across the whole NHS.
The contract within the confines of a limited budget and feedback from PCNs is designed to provide more flexibility and autonomy.
Confirmation has been given again that the additional roles scheme will remain in place.
Enhanced nurses have been introduced to the scheme. PCNs can have one enhanced nurse per PCN or two for PCNs with a list size of over 100,000. These nurses must have a postgraduate certification or diploma at level seven or above in specialised areas of care.
PCNs will be able to recruit other direct patient care non-nurse and non-doctor MDT roles if agreed with their ICB.
Funding arrangements for MHP roles (subject to existing requirements on first MHP post) will be for agreement between the PCN and the mental health provider, subject to ICB approval. All MHPs will continue to be employed or engaged by the mental health provider.
Caps on Advanced Practitioners will be removed.
PCNs will be able to claim reimbursement for the time personalised care roles spend out of practice undertaking training or apprenticeships to obtain a level three occupational standard.
The contract will also be changed to make permanent the flexibilities to the performers list of regulations brought in during the covid pandemic. These enable practices to continue to engage a variety of medical professionals to operate as part of the primary care team. More details to follow.
The proposed 2% pay growth uplift to the overall additional role’s reimbursement scheme is a planning assumption which may change. We all know this is not enough and the 2% increase on top of the minimum wage increase could have a significant and detrimental impact on General Practices.
The PCN Clinical Director role specification will be simplified to focus on coordination of service delivery, allocation of resources, supporting transformation towards Modern General Practice and supporting the PCN role in developing integrated neighbourhood teams.
Lastly, in the section, I know that some of you who hold the PCN Manager title will be disappointed not to receive recognition in the ARRS.
The good news is that the PCN Clinical Director, leadership and management payment, and core funding will be combined into one single pot with no conditions on how this is to be spent. However, I know that being outside of the scheme can make you feel vulnerable and less secure in your employment. It is a shame, but it is not a barrier to permanent employment.
For more information on the Veterans Health toolkits, please visit Veterans' healthcare toolkit: Veteran friendly GP practice accreditation | RCGP Learning or email Andy here: andrew.king26@nhs.net.
The 70% regular monthly payment will remain.
To receive the 30% access and capacity payment, the Clinical Director needs to certify to the ICB on 1st April 2024 that every practice has met the 3 components of modern general practice and can demonstrate:
Better digital telephony
Simple online requests
Faster care navigation
Moving forward, the letter indicates the proposed funding streams are
Capacity and Access 70%
Capacity and Access 30%
Core Funding (To include the CD and leadership and management funding)
The Additional Roles Reimbursement Scheme
Enhanced Access
The care home premium
1️⃣ . Reread the letter and watch the General Practice Webinar, where Amanda Doyle explains the changes and their rationale.
The GP webinar recording from 29th February 2024 can be found here: General Practice Webinars. Discuss this with your management team and wider network.
⁇ . What do you see as the advantages and potential disadvantages for your network?
2️⃣ . Solidify the vision of the network and governance underpinning decision-making.
3️⃣ . Review your workforce plan.
⁇ . Does the addition of an Enhanced Nurse change things?
⁇ . Are you maxed out, or do you now have the opportunity to add more people to your team.
⁇ . Do you have a workforce plan that acknowledges professional development and retention strategies?
4️⃣ . Communicate to your team.
⁇ . What does the contract mean for them? Is it business as usual, or will some things feel uncertain for them?
5️⃣ . Telephony data
PCN’s have been asked (but this is not mandatory) to better substantiate:
How busy we are
What the scale of the demand is
Where we need additional support
The contract letter calls for practices/ PCNs to provide telephony data on:
Call Volumes
Wait before call abandoned
Calls abandoned
Call back requested
Time taken to answer calls
Missed call volumes
Call backs made
Average call length time
This is something to discuss and add to the work plan, as understanding the data yourself will be helpful in understanding your demands and unmet demand.
You could also include your online access data too.
6️⃣ . Evaluating 23/24
In January, we published a blog titled ‘What to focus on in Q4’, and the checklist is still valid if you want to understand what the network achieved in 23/24, what worked well and what could be enhanced.
If you want to address or mitigate these risks, networks will need to get their finances in order and address the risks and issues in the networks.
7️⃣ . Create your strategic plan for 24/25
Finally, now is the time to start drafting your strategic plan for the year ahead. It does not have to be exact or perfect, but at the very least, it could include:
The vision and values for the network
An overview of your practices and population in the form of a map which is always helpful
Any new developments that will affect your population growth (New housing developments, etc...)
3 - 5 core priorities and how these will be measured
A strengths, weaknesses, opportunities and threats analysis ( SWOT) for each of your priorities
Who the key stakeholders are, and who you want to increase engagement with
The management structure
Current and potential future services
Your current and proposed future workforce
An action plan for the next 90 days
Regarding priorities, if you are brand new to your PCN and want some ideas to discuss with your network, along with finding out what they already have been working on and what is important to them, the following topics should spark some conversations.
Health inequalities
Workforce retention
Veteran health
Capacity and access
Mental health
Women's health
Patient education
Building more integrated neighbourhood working , capacity, and access may also be priorities now that the PCN Clinical Director role specification is simplified to focus on coordinating service delivery, allocating resources, supporting transformation towards Modern General Practice, and supporting the PCN role in developing INTs.
These suggestions are just to get you started. There will be no shortage of ideas.
The challenge will be just focussing on a few that you can really make a dent in.
I wanted to close out this blog with a few concluding thoughts on this stepping-stone contract, which I think will split PCNs into 3 main camps.
Camp 1:
For well-organised networks, the increased flexibility should enhance their performance. The freedom to streamline activities and organise resources based on the needs of their population will enable them to support core practice demands alongside proactive and planned care.
Camp 2:
These networks may find the year-long contract difficult to accommodate because it is short term or could find the reduced accountability and direction a welcome relief that provides them with the opportunity to maintain their current position. This could have a positive, neutral, or negative impact o their network.
Camp 3:
These networks may still be wrestling with issues such as the vision for the network, trust, conflict, governance, operational management, recruitment, and retention.
The increased flexibility and reduced accountability regarding what funds are spent on may weaken the desire to collaborate with these networks by simply devolving primary care resources that focus solely on each practice with no or limited network-level working.
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I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 290 episodes. I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.
I have managed teams across multiple sites and countries, have an MBA in Leadership and Management in Healthcare, have been published in the London Journal of Primary Care, and am the author of over 250 blogs.
I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.