This briefing is to update you on the development of Primary care networks (PCNs) which were established on 1 July and to provide advice on the contribution of local government to this important change to the health and care landscape.
Councils and health and wellbeing boards will want to be involved and informed of the development of PCNs, which will deliver primary and, increasingly, community care. It is important to the success of these networks that local government and wider local partners are involved.
At a national level the Local Government Association (LGA) is working with NHS England/Improvement (NHSE/I) to underline our shared commitment to partnership working when implementing these important changes. NHSE/I have emphasised that they want to take forward the development of PCNs in a collaborative way, we are keen to help make this a reality which we recognise requires real effort and sustained engagement at every level and on an ongoing basis.
Therefore, colleagues' feedback on what is working well and what is not would be very helpful at this stage so that we can feed this back into national discussions. Some councils may already be involved in, or at least aware of how PCNs are developing in their area, but this will not be the case everywhere. This briefing summarises the process for implementing PCNs, sets out implications for councils and joint working, and highlights the importance of doing this in a way that works for all partners locally.
The NHS Long Term Plan focused heavily on the creation of PCNs as the key delivery vehicle for integrated neighbourhood working, bringing together primary and community care. General practices are required to come together as a network to work with populations of between 30,000 and 50,000, making sure every person is covered. The NHS Long Term Plan describes them as the building blocks for integrated care systems.
Over the next five years, they will take on additional activity in line with funding rising to £1.8bn by 2023/24. This will be channelled through the regions from 2020 to 2023, with responsibility passing to integrated care systems (ICSs). PCNs will be funded through a nationally set contract, for Direct Enhanced Services, which specifies a range of nationally set service standards, as well as was is required to access additional funding for new healthcare roles, which will be part of an expanding multi-disciplinary team.
This funding is to be used to employ over 20,000 additional staff by 2024/24, such as 1,000 trained social prescribing link workers by the end of 2020/21, as well as clinical pharmacists, physiotherapists, physician associates and paramedics. The funding must be used for newly created roles and not to support existing staff. The contract also sets out nationally set service specifications, which have to be achieved progressively over the next few years, for example:
- from 2020/21 be able to assess their local population by risk of unwarranted variation in health outcomes
- by April 2020, provide anticipatory care with community services and personalised care and help improve early diagnosis of patients in their own neighbourhoods by 2023/24, starting with cancer diagnosis by April 2020
- implement the Enhanced Healthcare in Care Homes framework and structured medication reviews by April 2020, and provide NHS support to all care home residents who would benefit by 2023/24
- join up the delivery of urgent care in the community, including where advice or support is needed out of hours
- align with reorganised community mental health services
From this month, the contract also requires the provision of extended hours access. NHS England and Improvement will undertake a review of access with the outputs to be implemented by 2021/22, starting this year
The LGA has strongly welcomed the focus on and investment in integrated community working to look after people better in their own homes in the Long Term Plan. It has the potential to make a significant impact to people’s lives both in terms of their access to person-centred care and support and in improving health and wellbeing outcomes. It is critical, however, that successful neighbourhood working is built on effective joint working with partners, including social care, district councils and public health.
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Development of Primary Care Networks, 18 July 2019