Is your primary care network ready for new members?

Justin Cumberlege, a partner in the healthcare law firm Hempsons, suggests how Primary Care Networks should prepare to work with other providers

Published in Practice Management March 2020

The update to the GP contract agreement 2020/21–2023/24 (Contract Update) states, ‘Investment and Evolution committed to amending the Network Contract DES from 2020/21 to include collaboration with non-GP providers as a requirement, and that the Network Agreement will be the formal basis for working with other non-GP providers and community-based organisations’ 1, 2.

Schedule 7 of the Mandatory Network Agreement states that it is to refer to or set out the arrangements members of the Primary Care Network (PCN) have working with organisations outside the PCN.3 However, the Contract update envisages the PCN as a whole working with outside organisations and, indeed, many people have already jumped to the conclusion that Schedule 7 is to set out the terms on which other organisations may be non-core members of the PCN. It is unlikely the terms are going to be the same for each organisation, so the PCN will have separate agreements with each of them.

Schedule 7 may contain some red lines. For example, it might state that the non-members can attend PCN meetings only if invited, and not vote. It might state they have no sight of the PCN finances, but that they must adhere to the PCN’s agreements relating to the workforce (Schedule 5).

Has your PCN considered the terms on which it will work with other organisations, and who those organisations might be?

Finding the right people to work with is often challenging. Working out your negotiating position beforehand is essential if you are going to control the eventual terms of collaborating.

What relationship are you seeking?
A memorandum of understanding (MoU) is a good first step to agree the parameters without being fully committed. It is usually a non-contractual document, except perhaps in respect of intellectual property rights.

The next step may be an alliance agreement that goes into greater detail as to each party’s expectations; but only a few will be contractually binding. It would have provisions as to what each party is expected to provide, showing their level of commitment and resources.

The last stage is a contract, which is a legally enforceable relationship. Only at this level will you have to agree precisely who is going to do what, and how much each will receive (or what proportion of the budget and the risk/gain share), and where the risks lie. With a contract, which may be a joint venture agreement with several parties, there will be the commitment to enable the development of a sustainable longer-term integrated care service for the benefit of patients.

1. British Medical Association (2020) Update to the GP contract agreement 2020/21.  (accessed 24 February 2020)
2. NHS England, British Medical Association (2019) Investment and evolution: a five year framework for GP contract reform to deliver the NHS Long Term Plan.  (accessed 24 February 2020)
3. British Medical Association (2020) Network Contract Directed Enhanced Service Mandatory Network Agreement.  (accessed 24 February 2020)