• Tara Humphrey

The 2022/23 Network Contract Directed Enhanced Service Update

Updated: Apr 10


AKA The 2022/23 Primary Care Network (PCN) DES Update


What to focus on in Q1


As always, I write these updates with new PCN Managers and Clinical Directors in mind.

By new, I mean less than 9 months in post or you may have more than 9 months PCN Management experience, but have joined a new network and need reminding of the fundamentals.

The 2022/23 Network Contract Directed Enhanced Service Update was released on 31st March and these are my initial thoughts.


Getting started | How I read the DES


When I approach reading the PCN DES updates, I will first go to:

The NHS Confederation via their Primary Care Hub App for their summary. They are always quick off the mark and have summarised all of the key dates the guidance presents. The Confed summary lets me know:

  • What will need my attention in Q1

  • What I need to start strategically planning

  • What I need to be mindful of but not stress about

Details on how to join the NHS Confederation can be found here.

I also review our latest THC update, which in this care was the Spring Update we published on 8th March. This gave us a heads up on what was coming relating to funding, extended access and the Impact and Investment Fund.

I will also head over the EGP learning and Ockham Health, as they usually produce excellent updates relating to Primary Care Networks.

I like to source a few viewpoints on this important document, but it’s crucial you also develop your own thoughts on this strategic document and can critically appraise and decide on the next steps of your network.

I then like to print the document off and put it in a folder. For me, the PCN DES is an essential document that I refer to all of the time, so having it printed off and on my desk at all times is really helpful. I also have it on my desktop computer, along with a copy of the Impact and Investment Fund Indicators. You do what works for you.

This document is 134 pages, but don’t worry, it’s a well-written specification and not a book you need to read to cover or in one go. Also, a big chunk of the document is job descriptions which inform the DES requirements, but your network will already have a lot of roles in place so work with your management team to help understand the network's portfolio to date.


What do I need to focus on now?

Extended Access

Because the NHS Confederation has presented the timeline and as a member, I get to observe the conversations taking place, I know extended access is a significant piece of work for me to get up to speed on.

Whilst the ‘go live’ for this increased service (inclusive of weekend provision), commences on 1st October, a lot of planning needs to take place and I will need to further my understanding of the network's position on this.


Governance Review

As a new manager or CD, the network agreement will be an important document to review and update.

Listen to the podcast I recorded with Dr Claire Sieber, mediation specialist for further insights on the importance of the network agreement.



Developing and delivering local improvement pathways and workforce strategy and execution

In my view, these activities are intertwined, as ideally, we would first work out what we need to do to enhance the care to our population, alongside reducing the stress and often unmanageable workload on the current workforce. To inform our workforce strategy, I would want to ensure we:

  • Include the general practice workforce gaps and not just the PCN additional roles we can recruit to

  • Work in partnership with our population and wider stakeholders

  • Are using information systems like Ardens or Apex, or an equivalent to better understand our population’s health

The role of the Clinical Director

The document includes the role of the Primary Care Network Clinical Director. If you are a new CD in post, check out page 21.

If you are a PCN Manager, review this section to better understand how your role complements and integrates with the CD. Also, check out the blog, What Does a PCN Manager Do?



Business as usual services and activities

The next step would be to understand the business as usual activities.

  • The vaccination programme – (If you are still delivering this)

  • Extended Access which will move into Enhanced Access from 1st October

  • Social Prescribing

  • Enhanced Care in Care Homes

  • Cardiovascular Disease (CVD)

  • Medication reviews and medicines optimisation - formally listed as Structured Medication Reviews

  • Early Cancer Diagnosis (ECD)

  • Tackling Neighbourhood Health Inequalities – This is new

  • Delivering on the Impact and Investment Fund - This is being reintroduced

  • Monitoring network performance

  • Recruitment

  • Stakeholder management

Local contracts and projects PCN are also delivering on:

  • Local development plans

  • Practice Incentive Program (PIP)

  • Local Incentive Schemes (LIS)

  • Enhanced Services (ES)

What you will need to ascertain is;

  • Who is leading in what?

  • What is working well?

  • What requires your attention?

A simple DES tracker will support you with this in the form of an excel spreadsheet, which in one column will list the requirements and then in other columns, provide space for a progress update. We provide for this in our PCN Accelerators Programme

The key timelines

Below are some of the key timelines we will need to work towards with some things to consider.

This timeline will inform you what you need to work on now and what can wait. You can and nor have to, do everything at the same time.


Pg


Initial deadline

Service goes live

Things to consider

Submit Enhanced Access plan to commissioners

46

31st July 2022

1st October 2022

  1. Who is our PCN extended access lead?

  2. What do we want?

  3. What is currently working well?

  4. What needs improving?

  5. How will we engage our patients in this?

  6. Who and what do we need to make this successful?

Commissioners must agree and the Enhanced Access Plan with PCNs

46

​31st August 2022

1st October 2022

What does our comms strategy look like and what management resource is going to be dedicated to this to ensure a smooth go-live rollout on 31st October?

Data sharing and processing arrangements start Enhanced Access delivery must be in place

46

1st October 2022

This will require a review of the current arrangement and advice from your Data Protection Officer (DPO).

Extended Access goes live

46

1st October 2022

Expect some teething problems if creating a whole new service, but as planning for this is started in March, all will be fine.

Commissioners must agree an estimate of unclaimed ARRS funding for 22/23

41

​31st August 2022

If you have a track record of using all your ARRS funding allocation, pay close attention to this opportunity.

Whilst direct recruitment may be challenging, providers of clinical services, for example, FCPs, pharmacists, and SPLW may be able to ramp up the services to serve you and your population.

All PCN staff must complete refresher training for Shared Decision Making

63

30th September 2022

I would task a care coordinator with this action.

Personalised Care Design must be complete

63

30th September 2022

On 1st October

Delivery of a proactive social prescribing service for an identified cohort

Ideally, you have a clinical lead which is not the CD supporting this element in partnership with your social prescribing team.

Personalised care review must be complete along with shared decision-making audits

62

31st March 2023

This is important but this would not be my focus in Q1. This will inform our plans for Q2.

A PCN must contribute to the development of ICS Anticipatory Care design

61

Late 2022

Late 2022

This is important but this would not be my focus in Q1. This will inform our plans for Q2.


Summary


Here is a plan of action for you to modify and meet your network needs.

  1. Discuss the PCN DES with your Clinical Director and Management teams

  2. Update /make a DES and workstream tracker to ensure we have all of the requirements easily to hand and to assess how the network is performing against these

  3. Review or set in motion your approach to creating a robust workforce strategy

  4. Ensure the PCN either has a seat in the extended access steering group or if we need to form one

  5. Ensure the PCN is aware of the IFF indicators and updates

  6. Meet with the PCN finance lead to ensure they are aware of what funds will be coming to the network. This can be found on page 71 in the DES

  7. Update and work to a 90-day plan

If you would like a guide on how to present the latest updates to your network, check out our free slide deck here.

Final thoughts

There is a lot to do and it can be overwhelming BUT, it's also hugely exciting.


This is a job not to be done alone. You need a team around you and need to stay in close communication with them and the wider network. Effective communication and honesty are key.


Work in partnership with others and share your ideas and I’m sure they will help, because our networks are all so different. What may seem obvious to you will inspire others to do things differently.


As my thoughts and approaches evolve, I will be sure to share these with you.


  • If you’re new to your PCN Manager role and are unsure of what is expected of you, please check out our PCN Accelerator Programme here.

  • If you are a new Clinical Director, please check out PCN Plus here



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Tara provides project and network management and training to Primary Care Networks, coaching support to clinical leads and has worked with 11 Training Hubs and 19 Primary Care Networks to date.


Tara has an MBA in Healthcare Leadership and Management, is published in the London Journal of Primary Care, is the author of over 200 blogs also hosts The Business of Healthcare Podcast.


Find out more about THC Primary Care at www.thcprimarycare.co.uk


And follow Tara on Twitter @THCPrimarycare