Primary Care Network Workshops

Tuesday 2nd , Wednesday 3rd and Thursday 4th April

2019

Lunch and Registration 13:00 Welcome 13:30 Primary Care Networks • What are they? • What needs to be done.

13:30

Federations how can they support? 14:10 Primary Care and Community Services Integration 14:20 Panel Q&A 14:30 Tea and coffee 15:00 Primary Care Networks space 15:00 Next Steps 16:30 Close 17:00

Agenda

Dr Kiren Collison Clinical Chair

Oxfordshire CCG

Aims for today 1.Background 2.Practical next steps 3.Questions 4.Time with your proposed PCN 5.More questions and discussion 6.Any issues? What further support?

• Don’t panic • This is a 5 year plan • CCG and LMC are here to

guide you through it

Context • The NHS Long Term Plan • The GP contract reform • Primary Care Networks

(PCNs) are a key part

Wider

Working with other Health, Care and 3rd

Sectors

Working with other practices

Practice

What is a primary care network? Local Community of 30,000-50,000

McGovern L, Miller G, Hughes-Cromwick P. Health Policy Brief: The relative

contribution of multiple determinants to health outcomes. Health Affairs. 21 August 2014. Available from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_123.pdf

The bigger vision

What are PCNs designed to do? 1. Use data to design services around the needs of

the population 2. Proactive, coordinated care Prevention Health inequalities 3. Connect patients to other services (e.g. health, care or third sector) 4. Support the whole system

Why should we sign up?

• PCNs shown to be successful elsewhere

• Funding increasingly channelled into PCNs

• Lose out on funding if opt out • Greater influence

Potential challenges • New way of working Doing a lot for the first time • Relationships and possible disputes • Clinical Director responsibilities • Management and admin capacity • Data • Workforce - recruiting, supervising, liabilities, costs • Legal and tax advice

How are we going to get there? • ‘Ground-up’ approach

• CCG and LMC to support practices

• Network Contract DES - vehicle

for general practice taking a leading role in every PCN

PCN DES

Workforce Funding

7 specs System

1) Additional roles

• Additionality rule • New roles added from 20/21 • From 20/21 reimbursable rate calculated based on

weighted population

2) Funding Practice Support Practice participation (£1.76/weighted pt/year direct

to practices) Network Support • Core PCN funding (£1.50/head for 19/20)

• Clinical Director (£0.51/head for 19/20 then £0.69/head)

Access • Extended hours DES (£1.099/head for 19/20 then £1.45/head)

• Improved access (GPAF) (~£6/head) from 2021 Investment and Impact Fund

• Further details awaited

And in return… 7 national specifications: 2019 2020 2021

2019 2020 2021 • Extended Hours access

integrated into networks – 100% of network population

• Structured medication review

• Enhanced health in care homes

• Anticipatory care (with community services)

• Personalised care • Supporting early cancer

diagnosis

• Cardiovascular disease prevention and diagnosis, through case finding

• Action to tackle inequalities

Plus… • Support the system • Making best use of resources • Engagement with patients – including

‘seldom heard’ • Additional services based on local need

Tuesday 2 April 2019

Wednesday 3 April 2019

Thursday 4 April 2019

Dr Raman Nijjar Dr Matt Mayer Dr Richard Wood

Chair Oxfordshire LMC

Chief Executive Officer Oxfordshire LMC

Chief Executive Officer Oxfordshire LMC

Next practical steps

Forming a PCN • Size • Restrictions:

– Geographically Contiguous – No doughnuts!

• Nominated Payee

Clinical Director & Governance • Clinical Director

– Who • Clinician working within your PCN. • COIs

– How • Governing Body

– How are practices represented? – How do you make decisions? – Other concerns

PCN Structure • Workforce • Pensions • VAT • Contractual liabilities

“We’ll all pitch in”

Pensions VAT CQC

! Liability

“We’d like one of our practices to lead on this”

Pensions CQC Easier for most Incentive for the keen

! Liability ! VAT

“We’ll ask our federation to do this”

Liability Managerial Easier for most

! ? VAT ! ? Pensions ! ? CQC

“We’ll team up with our local community trust who can help us

deliver this”

Pensions CQC Easier for most Liabilities Diverse staff

! VAT ! ?GP Autonomy

4.

Network Agreement • Clauses – sign by 15th May • Schedules – sign by 30th June

– Schedule 1: Network specifics and meetings – Schedule 2: Additional Terms – Schedule 3: Activities (e.g. KPIs) – Schedule 4: Financial Arrangements – Schedule 5: Workforce – Schedule 6: Insolvency – Schedule 7: Arrangements with organisations outside network

• You need to keep this up-to-date!

Dr Kiren Collison Clinical Chair

Oxfordshire CCG

Timetable for DES introduction

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

Developing support • CCG Locality meetings: discussions at the

January and February meetings • CCG and the LMC: discussions on the significance

of the contractual developments • CCG, GP Federations and Oxford Health:

discussions as potential delivery partners in the PCNs

Ongoing support to PCNs • PCN workshops • 3 sessions per practice (£900) • 1 session per week per PCN (for 10 weeks)

– Early indication of PCNs – Engagement in June integration workshop

• Integration workshops – June tbc • Integrated multidisciplinary working workshops • Development of support programme locally and by NHSE • CCG locality meetings to advance, support and share learning • FAQs

Tuesday 2 April 2019

Wednesday 3 April 2019

Thursday 4 April 2019

Dr John Harrison Andrew Elphick Helen Shute

Chairman PML

Chief Executive Officer PML

Chief Executive Officer OxFed

Tuesday 2 April 2019

Wednesday 3 April 2019

Thursday 4 April 2019

Pete McGrane Tehmeena Ajmal

Clinical Director, Community

Oxford Health NHS Foundation Trust

Lead for Primary & Community Integration Oxford Health NHS Foundation Trust

Panel Questions

Breakout questions • Who will be chosen as accountable clinical director? Will

the job be shared? • How will the process take place? By appointment or by

election? How would voting work? • Who will receive funding on behalf of the PCN? • How will you decide what goes into your network agreement

(decision-making processes, employment model, accountability)?

• Any issues that need to be resolved before 15th May?

Next steps

By 15 May • The Names and the ODS codes of the Member

Practices. • The Network list size, as of 1 January 2019 • A map clearly marking the agreed network area • The initial Network Agreement • The single practice or provider that will

receive funding on behalf of the PCN • The named accountable Clinical Director

Do you need further support? • Reading to help you:

– GP Contract – BMA Handbook – FAQs

• Contact the LMC ceo@bbolmc.co.uk • Contact the CCG occg.pcn@nhs.net

• Don’t forget: you can use your partnership agreement for a lot of the schedules.

• Also, note: CCG-funding for time in lieu can now be used for legal advice instead. £900 per practice + £3000 per PCN!