PCN contracts could be varied by ICBs locally to develop neighbourhood services

ICBs will be allowed ‘greater flexibility’ to tailor contract arrangements for PCNs to facilitate the creation of neighbourhood services, NHS England has revealed.

In a variation to the Network Contract Directed Enhanced Service (DES) specification for this financial year, the NHS England said that the DES has been updated to enable ICBs to ‘request local variations’.

Experts have suggested that this introduces the ability for ICBs to vary the PCN DES at a local level with the approval of NHS England, and could potentially ‘kill the possibility of single neighbourhood provider contracts’, which were announced as part of the 10-Year Health Plan.

NHS England said that ‘local variations agreements’ introduced as part of the change are intended to allow ‘approved variation of limited parts’ of the DES specification.

In an explanatory note, NHS England said: ‘This allows greater flexibility to tailor arrangements to local circumstances where existing local contractual routes may not be sufficient.

‘The changes could support ICBs that are developing neighbourhood services by using the Network Contract DES framework.

‘These amendments are separate from the proposed multi neighbourhood provider (MNP) and single neighbourhood provider (SNP) contracts, which will be subject to a separate DHSC and NHS England consultation.’

When submitting a request for variation, ICBs should ‘provide sufficient detail’ to enable NHS England to understand the ‘proposed model and its intended effect’, the documents added.

This should include the rationale and ‘expected benefits’ of the proposal, any patient cohort or population to which it is directed, the role of each participating practice, any shared delivery model or operational integration across practices, and any relevant partnership working with other providers or stakeholders.

Specialist medical accountant Andy Pow said that this was a big change for PCNs ‘dressed up as something quite vague’, and that it could mean PCNs will be the vehicle to implement neighbourhood services.

Mr Pow added: ‘It could be killing off the possibility of single neighbourhood provider contracts, because why would you need an SNP contract if you can change anything you want thought the actual existing DES that you’ve got.

‘Which could be positive, because actually creating another tier of contracts could be another nightmare to deal with.

‘But this could mean that PCNs are being moved from a mechanism to employ staff across practices to being the model through which they [NHS England] are possibly going to try and change general practice provision – so it’s changing the whole concept of what a PCN is.

‘Whether that is a good or bad thing, we just don’t know yet. I can see it working, but I can also be a disaster. It is arguably the biggest shift in resourcing that we have seen since the PCN DES came in.’

Mr Pow told Pulse PCN that he cannot see the two contracts existing alongside each other because it would lead to confusion to ‘who is doing what’.

He said that the new powers could be used differently depending on the area, adding that some ICBs could use it advantageously for GP practices, but that others could use it to ‘take away control’.

Mr Pow added: ‘At the moment the GP practices control where and how the funding is utilised and a lot of it is used in a way to achieve the initial aim of supporting practices with the core work they do.

‘There is a nationally agreed contract which until yesterday was clear in the rules.

‘Now if the ICB decides something different it could have sizeable impacts on how the practices operate as staffing mixes will need to change.’

BBO LMCs chief executive Dr Matt Mayer told Pulse PCN’s sister title Pulse: ‘These amendments to the PCN DES are very alarming. It appears now that rather than having a nationally negotiated DES, we are transitioning to a “PCN LES” where systems will be able to impose changes to funding, targets, requirements, and access, upon PCNs and their member practices seemingly with no requirement for scrutiny by LMCs.

‘These changes have come completely out of left field and will cause enormous uncertainty and concern for practices. We need urgent answers as to what involvement the BMA had in these changes, and what steps they are taking to oppose and resist them.’

Last month NHS England said that the new neighbourhood contract models will be developed in this financial year.

The Government recently confirmed as part of a new framework that NHS trusts will have commissioning responsibilities for primary care, through new integrated neighbourhood organisation (IHOs) contracts.

A version of this article was first published on Pulse PCN’s sister title Pulse.