Updated: Oct 17
At THC Primary Care, we provide resources for Primary Care Network leaders and four times a year, we provide a summary of the PCN DES - and a suggested action plan of where to focus your attention each quarter.
On 30 March 2023, the 'Contract Specification for 2023/24 – PCN Requirements and Entitlements' document was released. Much of this document will shape your network's activity however, we recognise that many networks will already be delivering over and above on the asks of the DES.
In this blog, we cover the following:
Our approach to the PCN DES
An introduction to the PCN DES
An overview of 23/24 PCN finances
The PCN service requirements
Changes to the Investment and Impact Fund
Some ideas on what to focus on in Q1
To support this blog, you will need access to the following documents.
Let's jump in!
Section 1: Getting started | How I read the DES
The contract specification is typically referred to as the PCN DES.
When reading the PCN DES for the first time, I will first go to:
NHS Confederation, via their Primary Care Hub app, to check their summary.
They are always super quick off the mark and will always provide a high-level overview of all of the key changes.
Details on how to join the NHS Confederation can be found here.
I also reviewed our latest update, which in this case, was the blog titled '16 key questions to consider when reading the latest GP Contract changes published on 6th March 2023'. This gave us a heads-up on what was coming relating to funding, Additional Roles, and the Investment and Impact Fund.
🎯Most importantly, I will discuss the contract with my networks, starting with a conversation with the Clinical Director.
I can't emphasise enough the importance of sourcing multiple viewpoints on this highly significant strategic document. It's also crucial that you are able to develop your own thoughts and can critically appraise, and decide on, the next steps for your network.
Section 2: Introduction
On 30 March 2023, the 'Contract Specification 2022/23 – PCN Requirements and Entitlements' document was released.
This document is typically referred to as the PCN DES.
The PCN DES was first introduced in 2019, and the intention is for there to be a Network Contract DES until at least 31 March 2024, with the requirements of the Network Contract DES evolving over time.
This document sets out the obligations of:
Primary Care medical services contractors who participate;
The PCNs of which they are members
If you are brand new to your PCN, you need to read the document thoroughly.
If you are not new (and have been involved in the leadership of the network for a while), you can probably skip to the finance section as there are some changes.
Section 3: PCN Finances
Each network is set to receive the following (these are set payments):
Payment provisions and calculation 23 / 24
Clinical Director Payment
The Clinical Director payment for the period 1 April 2023 to 31 March 2024 is £0.72963 per registered patient per annum
Core PCN Funding
Core PCN funding for the period 1 April 2023 to 31 March 2024 is calculated as £1.50 multiplied by the PCN registered list size.
Enhanced Access Payment
The Enhanced Access payment for the period 1 April 2023 to 31 March 2024 is calculated as £7.578 multiplied by the PCN’s Adjusted Population.
Care Home Premium
This payment is calculated on the basis of £120 per bed for the period 1 April 2023 to 31 March 2024.
PCN Leadership and Management Payment
The PCN Leadership and Management payment for the period 1 April 2023 to 31 March 2024 is calculated as £0.684 multiplied by the PCN's adjusted population.
Capacity and Access Support Payment
The Capacity and Access support payment for the period 1 April 2023 to 31 March 2024 is calculated as £2.765 multiplied by the PCN’s adjusted population.
A shout-out goes to Zain Harper in the Primary Care Networks ...a Discussion Forum ( PCN ) Facebook Group, and Craig Nikolic, who highlighted the following (in comparison to the 22/23 contract):
The participation payment £0.729 remains the same. This goes straight to practices
£1.50 Core Funding remains the same
£120 Care Home premium remains the same
ARRS funding per role remains the same as the Oct 2022/23 revision
The PCN CD payment reduces from £0.736 per registered patient per annum, to £0.729
The Enhanced Access payment increases from £7.528 to £7.578 (adjusted pop.)
The PCN Leadership and Management payment has been reduced from £0.699 to £0.684 (adjusted pop.)
The Capacity and Access Support payment is £2.765 (adjusted pop.). The 70% IIF diversion will be paid monthly in 23/24
The Local Capacity and Access Improvement payment is a MAXIMUM of £1.185 (adjusted pop). This is the remaining percentage from the previous 30% IIF allocation
There is the potential for an ICB diversion in the above; “Where ICBs forecast that not all of the Capacity and Access Improvement payment IIF monies will be awarded, they should seek to invest these in local access improvement to general practice for the population where appropriate within wider ICB plans”
Each remaining IIF point has been reduced from £200 to £198
Variable payments will come from the Investment and Impact Fund and Capacity and Access and Improvement fund. The variability is due to the network's achievement and the improvement plan submitted.
Section 4: The Capacity and Access Support Payment
In 22/23, PCNs were entitled to the Capacity and Access Support payment based on the PCN committing (in writing to the commissioner) to reinvest this into additional workforce and increased clinical capacity to support more appointments and better access for patients.
This year, the Local Capacity and Access Improvement payment is a payment made in respect of documented improvements in the following key areas:
Patient experience of contact
Ease of access and demand management
Accuracy of recording in appointment books
PCNs must have worked with the commissioner to assess and record the PCN's position at the start of the 2023/24 financial year in relation to the three key areas, as set out above.
They must also consider how improvements in the PCN’s position (as at the start of the 2023/24 financial year) will be measured - and set the appropriate levels of improvement, which should be achieved by 31 March 2024.
In the original guidance, the deadline for submission of the plan was 12 May 2023. On 27 April, the submission date was moved to
30 June 2023.
Section 5: Service Requirements
The service requirements remain the same as 22/23 with the addition of the Local Capacity and Access Improvement plans.
The continuing services include:
Extended Hours Access and Enhanced Access
Medication Review and Medicines Optimisation
Enhanced Health in Care Homes
Social Prescribing Service
Anticipatory Care (whilst this has always been part of the DES, the requirements have, to date, been deferred).
Networks may also have other local (and PCN-based services and projects) they are delivering.
Section 6: The Investment and Impact Fund
As stated in the GP update letter, the number of indicators in the IIF will be reduced from thirty-six to five and will focus on the following:
Flu vaccinations x 2 indicators
Learning disability health checks
Early cancer diagnosis
A two-week access indicator
The remainder of the IIF will be entirely focused on improving patient experience. This is based on the patient's experience of contacting their practice, receipt of a timely response, with an assessment, and/or to be seen within the appropriate time period (according to clinical urgency).
70% of the total funding will be provided as a monthly payment to PCNs during 2023/24 via the Capacity and Access Support Payment, as already discussed in the finance section.
At the time of writing, the assessment of need is still unclear.
It is also worth noting, the IIF indicators are not mandatory, and networks can choose not to pursue these.
Section 7: What to focus on in Q1?
Whilst every network is different, you may find value in addressing the following activities.
1. Send the PCN accounts off to the accountants
I would also get a quote for the year ahead, especially those networks who are moving to quarterly accounts.
2. IIF 22/23
Review your IIF performance from 22/23 to confirm how this money will be reinvested back into the network.
3. Present a summary of the 23/24 DES to your network.
The network will be looking to you to know what to do next.
4. PCN Finances
Confirm your PCN finances so you can map these for the year.
It's important to include all of your anticipated expenses and how much you plan to hold back for contingency.
The NHSE ready reckoner can be found here
Ardens Manager is also incorporating the financial allocation for each PCN in their platform.
5. Agree the Clinical Director's Payment
The PCN Board should agree on the PCN Clinical Director reimbursement for the year, sooner rather than later. The Clinical Director's payment has been reduced, but this doesn't mean the CD should accept less. Can this payment be topped up from other funding streams?
6. Review the Capacity and Access Payment 2023/24 Guidance
The guidance can be found here. Work with your network to identify how best to approach reviewing:
Patient experience of contact
Ease of access and demand management
Accuracy of recording in appointment books
This guidance also requested that networks sign up to the General Practice Appointment Data (GPAD) Data Provision Notice and improve the accuracy of appointment recording.
Your plan needs to be agreed with your commissioner by 12 May 2023.
🎯 My first port of call for this would be my Network Practice Managers and the ICB.
7. IIF 23/24 and Workforce Planning
Review the Impact and Investment Fund indicators for 23/24 and create a plan for achievement.
For the networks who relied heavily on their PCN pharmacy workforce to deliver the Impact and Investment Fund indicators, now is the time to review how best this workforce can support other elements of the DES, and the access agenda.
8. Start creating your Business Plan for 23/24.
Whilst the practices are the network, depending on how your network has progressed to date, these may still be seen as very different entities, so it may be worth centering conversations around the following themes:
What's the vision?
What's being asked of us?
What are our population's health needs?
What services are working well?
What service provision should we review?
Can we afford what we are planning to do?
What should we stop doing?
How are we monitoring our impact, which is meaningful to us?
9. QOF Quality Improvement Peer Review
NHS England has introduced two new Quality Improvement modules in 2023/24, which are to be discussed in two PCN peer-reviewed meetings.
Ideally, one meeting to plan (this is what we will do). The second meeting; to share what we did, what worked, and the lessons learned.
Try to have the first QI meeting this quarter.
It's worth noting that it's important not to review the PCN DES in isolation.
My initial assessment is that the majority of PCN activity is business as usual.
Whilst there is some reduction in payments, the majority of the Impact and Investment Fund targets have been removed. Also, the requirement for improving access has been a constant so it’s not surprising PCNs are required to support improvements in patient experience here.
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About the Author
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 200 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; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I 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.