GPs leaders have said, NHS England’s premises review will be key to the success of Primary Care Networks (PCNs), and with the review due to conclude shortly, it’s time to examine the challenges facing GP premises and look towards the future of property in PCNs.
Firstly, here’s a recap of what we know about PCNs so far, from structure to funding and staffing to new services, here’s our comprehensive overview.
What is a Primary Care Network?
A PCN amalgamates a group of neighbouring GP practices to cover a population of 30,000 to 50,000 patients. NHS England’s aim is that PCNs will provide support to member surgeries, the surgeries will collaborate to deliver patient services and pressure can be taken off GPs, as they’ll benefit from an expanded primary care team and shared network staff.
NHS England’s vision of PCNs is that they should be small enough to provide the personal care valued by both patients and GPs, but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care system.
Funding Primary Care Networks
A funding package, under the new five-year GP contract deal, will support the creation and staffing of PCNs, the full details of which will be published at the end of March 2019.
Figures released to date state that, a typical practice is set to receive over £14,000 each year for their initial and continued active participation in a primary care network. With PCNs receiving £1.50 per patient to cover administration costs, alongside payments for a clinical lead, staff and extended access.
Primary Care Network staff and additional services
The new five-year GP contract states that NHS England will fund 22,000 additional practice staff by 2023/24, the extra staff will include social prescribing workers, pharmacists, physiotherapists, paramedics, and physician associates. Early estimates show that an average PCN will take on 21 new staff each by 2023/24. With the aim of delivering additional services in communities, such as; physiotherapy, ultrasound and mental health support.
Primary Care Network uptake
Practices have until July 2019 to join a PCN but are not obliged to. However, practices who chose not to join a network would put themselves at a significant financial disadvantage. Leaving themselves without access to, over 50%, of the new funding available through the five-year GP contract deal.
Speaking at the Londonwide LMCs conference 2019, Dr. Krishna Kasaraneni (General Practitioners Committee, Executive Team Member) said: ‘First of all, not all practices need to get into a network. Let’s be absolutely clear. You can’t be forced into joining a PCN. So, if you as a practice choose not to that’s fine. But overall the general direction of travel is that it is a Direct Enhanced Services (DES), it is optional, but there’s going to be a lot of funding coming through to support it’.
With such incentives available one would suspect that the vast majority of practices will join a PCN by the deadline. In fact, the GP contract stated as of October 2018 that 88% of practices in England had already chosen to join or lead a PCN, according to CCG data.
The future of GP Federations
With many GP Federations covering practice lists of more than 50,000 patients, it is not a simple case of federations becoming PCNs. Dr. Richard Vautrey (BMA, GP Committee Chair) told Pulse in February 2019, that in most regions of the country, federations would be too large to count as a primary care network.
At-time of publishing, NHS England has not made a formal statement regarding the future funding of GP Federations, but we suspect that existing funding and contracts held by GP Federations will be run down and subsequently taken over by PCNs.
Primary care networks & premises challenges
A major challenge facing GP practices and the implementation of PCNs is surgery capacity. There is widespread concern among GPs that practices will simply not have room to accommodate the 20,000 new staff brought in through PCNs.
During the Londonwide LMC Conference, Dr. Kasaraneni said he too was experiencing this very problem, ‘I know the exact problems that you have. In my practice, the only place I’ve got left now is a car park and a loo to put any extra staff in, we hot desk because we haven’t got any capacity.’
As part of the GP contract negotiations for 2018/19 NHS England and the GPC agreed to carry out a review of the GP premises policy to ensure that it was fit for purpose, both now and in the future. This review will also incorporate the premises cost directions, which stipulates how premises costs incurred by practices are reimbursed and crucially how funding for premises improvements are delivered.
The issue for practices is that the implementation of PCNs is moving faster than premises policy and surgeries need for clarification on what support will be available to increase practice capacity. The conclusion and publication of the GP premises policy review and premises cost directions should go some way towards resolving this issue. However, NHS England has recently stated that the review was ‘due to conclude shortly’, but there is no timeframe for when it will be published.
The future of premises in primary care networks
Paul Conlan (GP Surveyors, Operations Director) foresees the following scenario for the future of premises in Primary Care Networks – more GP mergers, and here’s why.
With a very high percentage, if not all surgeries in PCNs by the July 2019 deadline most surgeries will soon be working in a collaborative manner if they aren’t already, when you fast forward, working collaboratively with neighbouring surgeries will become a normal working structure and environment.
Under the PCN structure, larger practices within a network will have a greater capacity, compared to smaller ones and will, therefore, absorb more new staff and services. In turn, one would expect patient demand to register for the larger practices to increase, with a detrimental impact on smaller practices. Creating the following issues; a greater proportion of funding flowing to larger practices, increasing their income while stagnating smaller practices incomes.
However, larger practices patient lists can’t increase ad infinitum and larger surgeries will still rely upon the specialisms of GPs from smaller practices, in order to deliver all the services PCNs require. Therefore, a mutual need is created, with smaller practices needing the capacity of larger ones and larger practices needing the skills of smaller ones, in order that PCNs function as a whole.
Another push factor towards mergers is practices need to mitigate their exposure to risk. Major risks include the GP recruitment crisis and succession issues. With the 2015 target of recruiting 5,000 new GPs still not met and the deadline for this removed, I think we can all agree that the GP recruitment issue is not going to be solved overnight. Equally the factors causing succession issues show no signs of easing. Merging surgeries reduces the risks posed by these issues, as a merger creates a larger pool of staff resource for all parties to draw upon.
To summarise Conlan is of the opinion that; PCNs will create practices mutual need to share capacity and GP specialisms, while establishing a culture of cooperative working, formalising this mutual beneficial situation by merging can then deliver further economies of scale, reduce exposure to risk and help ease recruitment and succession issues. When you bear these factors in mind an increase in practices mergers seems like a natural outcome of PCNs.
GP mergers – property considerations
See our guide on GP mergers for more information on what to consider from a property perspective or if you’d like to book a free GP merger consultation please fill out the below form.