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Primary Care Networks
How to register a network?
It’s quite easy to apply to the NHS Commissioners to register a new network. To register practices need to:
- Give their ODS code and identify the collective network patient list size (which is the same as at 1st jan 2019)
- Map the network area
- Enter into the core terms of the Network Agreement (national terms, with full agreement on local terms to be agreed by 30th June)
- Nominate a clinical director
- Agree a nominate payee - to receive the DES funding
The deadline is the 15th May 2019. Commissioners will, by 31st May, confirm that the PCN registration requirements are met and if there is full coverage in the area – this is currently a mandatory requirement and if not achieved there is scope for discussion between the practices, the LMC and the commissioners. The ideal population for a network is 30-50,000 patients.
PCN proposes a system of more integrated and coordinated care and deeper collaboration between practices in the network.
What do you need to consider before creating a network?
The national agreement has two parts, nationally agreed terms covering issues such as term of the agreement, termination arrangements, overarching principles and objectives, exiting a member of the PNC (voluntary or explusion), decision making, dispute resolution and data protection/confidentiality.
Local terms will include the requirements of the local authority which will focus on the needs of the community so issues such as how the services are provided, workforce issues, finance arrangements, governance and decision making, dispute resolution, data sharing, confidentiality and exit arrangements.
Before you agree to join a network, each practice should fully consider who the arrangements are going to work. It is critically important to explore issues with potential network partners such as:
- The legal structure of the network and there are various model i.e. a partnership, a limited company, a limited liability partnership, lead practice.
- Workforce – who is going to deliver services? Do you need more staff, both clinical and back office to administer the network? Who is going to employ those additional staff and be responsible for their management and supervision? This is already proving to be a bone of contention with network partners who do not want the responsibility of employing additional network staff. Network Partners can consider a form of indemnity in relation to liabilities of employing additional staff. In some models, there are proposals for joint employment contracts of employment with each network member. Our view is that this would be a complex arrangement to manage and that one network partner would still need in practice to appointed as paymaster and for HR purposes. There are some VAT issues with this type of model particularly in relation to staff not providing medical services and any sub-contracting arrangements to other practices in the network which may cause tax/VAT issues also so it’s important to take financial and tax advice.
- The PCN is required to appoint a clinical director, clinical pharmacist and social prescriber – NHS will provide funding on a 70/30 basis for these roles. The CD must be a GP or clinically qualified person.
- Finance – who is the nominated payee? What accountability should there be for the nominated payee to other practices? What service levels should be agreed for the receipt and distribution of funds to the network partners? Will the nominated payee need additional back office staff to handle the administration? If so, agreements need to be in place for the admin costs.
- Governance and decision making is also critical to the success of the PCN. Will you be able to work effectively with the partners in your network? Will there be a management/governing committee to run the network and make decisions? How will the voting arrangements work? Options include one vote per practice or a weighted voting system if there are varying sizes of practices in the network. NHS proposes that the networks will grow so the network partners will need to be fluid and flexible with a view to change in the future as the networks expand. There needs to be accountability and reporting to all network partners.
- Objectives of the network need to be clear – what is the vision for the delivery of services in the network?
- Dispute resolution and exit arrangements - the network agreements need clear exit routes for partners who wish to leave the network and/or if a partner in the network is not performing, then the network may wish to remove that partner – the legal terms of the network agreement need to identify how this happens.
- Data Sharing and Confidentiality - GDPR will apply, the network will need a privacy statement for patients and staff in line with current data protection rules and to put in place policies and procedures for the protection of data and rules about data sharing in the network.The network may decide to appoint an overarching DPO manager to monitor data protection and data sharing across the network in co-ordination with practice DPO’s.Similarly with confidentiality, all network partners need to be bound by the duties of confidentiality and its worth considering an overarching policy or minimum standard requirements for all network partners.
If the network partners can agree the framework along these lines for operation of the network, then it can move forward and start to explore with network partners and stress test the proposed arrangements in terms of IT compatibility, insurance arrangements (liability for greater workforces/increased patient list size and additional services), issues with NHS Pension – some of the proposed models are not NHS pension compatible but pending further updates from BMA and the NHS. Adjustments might need to be made to the model or structure if issues are identified.
How we can help?
We can provide advice and support to practices in:
- Advising on the options for operating models for your network and practices
- Drafting the Network Agreement (fixed price)
- Drafting Employment Contracts or Sub-Contracts (fixed price)