Is your primary care network ready for the future?

First published in Practice Management in February 2023.

After three years of being a primary care network (PCN), most have developed a way of making decisions, sharing the Additional Roles Reimbursement Scheme (ARRS) staff and the costs, as well as distributing any surpluses. Many have found some difficulties in the way PCNs have to operate, but also solutions which work as best as they can. Others have taken a further step and formed a company for the PCN, which helps in some respects, although not a total solution.

Being aware the Network DES Contract comes to an end on 31 March 2024, are you preparing for an uncertain future? To some extent, it will depend on how you think the services currently being provided by an increasing ARRS work force will be provided after then. This may depend on you. The integrated care board may have the freedom to re-provide those services by commissioning them form different organisations, and they will be looking for the one which is going to be the most competent in providing it.

That may not be the incumbent PCN if the integrated care board does not have confidence in the way that it has been providing the service, or has struggled with its clinical, operational or financial governance. Some have unfortunately had disputes between the practices of their PCN. That in itself does not mean that they are failing, but how they deal with them will show how robust they are. Assuming you are one of the many who consider that the PCN model works, and has a future, and is the best vehicle to deliver the services of the Network DES specification, then you should be prepared to ensure that you are commissioned to provide the services as from 1 April 2024.

‘It is important that the employment contracts are up to date, and that employees are being properly trained and supervised, and that you are able to retain them’

Part of that is looking at your current network agreements and seeing if they reflect what you are doing in practice. As I say, ‘It’s function over form’ where ‘function’ is what you do, and then ‘form’ is the structure in which you do it. You should ensure that the form re-enforces the function.

In practical terms, consider whether the PCN is working well and how it is working, and does your Network Agreement reflect this? If that is not the case, then you should analyse why you are not working well together and how that can be addressed, and how the Network Agreement should be changed to reflect how you should operate.

Also consider if the Network Agreement has sufficient checks and balances to oversee what is happening and that the funding is being properly applied.

It is important that the employment contracts are up to date, and that employees are being properly trained and supervised, and that you are able to retain them.

The PCN should be working with other organisations successfully, and have in place the appropriate agreements on which to build long-term relationships. This may be a contract, or a collaboration agreement, and importantly a data sharing agreement if care for the practice’s patients is to be provided by both you and the organisation. Being the centre of a network is going to secure your position.

A smooth running operation is usually a successful one, with the levers to keep the operation aligned, and one in which the ICB should trust to provide the services into the future. Now is the time to prepare.