What to focus on in Q4 - A Guide for Primary Care Network Leaders

It’s that time again for our regular blog feature, where we break down the main areas of what to focus on each quarter.

January 2023 marks the start of the 4th quarter and the run-up to the end of the 2022 - 2023 business year.

This blog is for anyone involved in the running of a Primary Care Network and aims to be a helpful resource to help focus and organise your network's activity.

In this blog, we provide the following:

1. A breakdown of the tasks required to support your end-of-year accounts

2. A summary of what to include in your PCN annual review

3. Questions to help you build your 2023/24 PCN plan

4. The advantages of working to a 90-day plan

Key Documents

To support this blog, you will need the following:

The latest PCN DES can be found here. The document was updated on 30th September 2022

https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-contract-specification-2022-23-pcn-requirements-and-entitlements/

The updated PCN Ready Reckoner reflects the recent changes and updates to the PCN income, and the maximum reimbursable ARRS rates effective from 1 October. Also included is the estimated PCN ARRS entitlement sums for 2023/24 to support PCNs with future ARRS workforce planning.

https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-financial-ready-reckoner/

Keep reading below, and also check out our Youtube video on this.👇🏾

1. PCN Financial Management

As we approach the end of our financial year (March 2023), we will need to have a handle on our end-of-year PCN finances.

The checklist below., which will need to be tailored for your setting, should provide a helpful guide.

In partnership with your financial lead and Clinical Director;

• Review finances ASAP to identify any underspend and develop a plan of action to spend this money.

Check your

1. ARRS allocation

2. Impact and investment fund spend from the year 2021/22 and projected income for 2022/23

3. Core funding

4. Leadership and development funding

5. System development funding (If this applies to you)

6. Any other local pots of funding, If this is applicable.

• Assign a cut-off date to ensure costs that the network incurred before the year's end is assigned to the correct financial year.

• Ensure all invoices are raised for work carried out this year.

• Ensure bank reconciliations are up-to-date and aligned to bookkeeping entries. This includes ensuring bookkeeping codes are consistent, and descriptions of bills and services are accurate and thorough.

• Review all subscriptions and check whether you are still fully utilising these services.

• Book an end-of-year meeting with your accountant and your PCN Board to help you financially plan for the year ahead and understand your position over the past year better, as well as discuss any tax implications.

• Archive any information and make sure this is clearly organised and labelled.

• Request for your PCN finances to be completed by a certain date. I know many PCNs who are yet to receive their 2021/22 finances back from their accountant.

• Schedule an end-of-year finance meeting, which includes some options on how you manage any underspend which can't be spent this financial year.

If you are in doubt, please seek advice from your accountant.

2. Conducting an annual review

A lot of work that goes into running a Primary Care Network may go unseen, so conducting an end-of-year Primary Care Network review can be key to highlighting;

1. The network's financial performance

2. Strengths, weaknesses, opportunities and threats

3. Data points that easily identify what the network has achieved

4. Key strategies to adopt moving forward

5. How the network staff feel about their role and the network

6. Things we need to start, stop and continue doing

You may want to include:

1. How many additional appointments the network generated

2. How has your network grown staff-wise

3. The clinical outcomes your personalised care and health inequality projects generated

In order for an end-of-year business review to be effective, do not do this in isolation.

1. Speak to your board

2. Work with your Practice Managers (without actually giving them work to do)

3. Survey your staff

4. Review patient feedback

3. Start creating your business plan for next year

Whilst we wait for the new Primary Care PCN DES to drop, there are still many things we can plan for:

1. How the PCN can best support practices

2. The professional development of our growing PCN workforce. What will they need?

3. The business model required to house the PCN. Does anything need to change?

4. The IT infrastructure needed to support our growing workforce. Does anything need to be improved?

5. The premises infrastructure required to support our growing workforce. Is there anything we can do?

6. Succession planning of the leadership and management team (if required).

7. What does an integrated neighbourhood team look like to us? Are there already some building blocks in place? In this article written for Pulse, we have provided 20 questions for consideration.

The intention is not to have your business plan 100% completed before the 23/24 PCN DES is released but to have a good idea of what you would like to build on.

4. A final few words on planning

At THC Primary Care, we like to work toward a 90-day plan. This approach provides the opportunity for short-term actions to enable immediate improvements while also laying the groundwork for more strategic planning.

Additionally, the shorter timeline helps keep team members focused and motivated and moves us from just focusing on the day-to-day priorities.

Your plan can be a simple plan on a page that identifies the following:

1. What needs to be done?

2. Who is going to do this?

3. When does this need to be delivered?

4. What information or support is needed to make this happen?

5. Business as usual activities

Alongside the above priorities to be completed in Q4, we have also provided a list of business-as-usual activities for Primary Care Networks.

DES specifications

1. Social Prescribing.

2. Extended Access.

3. Enhanced Care in Care Homes.

4. Cardiovascular Disease (CVD).

5. Medication reviews and medicines optimisation.

6. Early Cancer Diagnosis (ECD).

7. Tackling Neighbourhood Health Inequalities – Our introduction to health inequalities can be found here.

8. Personalised Care - Our introduction to personalised care can be found here

9. Delivering on the Impact and Investment Fund.

10. The vaccination programme, if you are still delivering this.

Details of the DES specifications can be found here.

Other areas for attention

• Workforce planning and recruitment.

• Stakeholder management.

• Local contracts, projects and proposals the PCN is also delivering on.

• Contract reviews for your additional role reimbursement providers. Guidance can be found here

We hope you found this useful.

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 80 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 three 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 massive role in my life.