NHS England: PCN services to be phased amid ‘overburdening’ risk

In draft guidance published today, NHSE says it will phase in new PCN service specifications due to start in 2020-21, so that they do not overwhelm PCN capacity or swamp the support available from the wider system.

There are five new PCN services due to start in 2020-21 but, according to the ”draft outline” specifications, only two must be implemented “in full” from that year.

These two are structured medicine reviews and enhanced care in care homes — although the draft specifications acknowledge many PCNs have lots of care homes in their patch and say NHSE is “considering this issue further”.

NHSE wants to phase in the other three specifications “to ensure they are deliverable as PCN workforce capacity grows and as the wider system infrastructure develops to support them”.

These three (early cancer diagnosis, personalised care and anticipatory care) will see their requirements “phasing in… over the period from 2020-21 to 2023-24”.

The original PCN contract framework, from early 2019, said of these services that the “requirements [would] commence in 2020-21 and develop over the subsequent years”.

The draft specifications document, released today, underlines NHSE’s desire for an additional 20,000 clinical, non-GP workforce to funnelled into PCNs as quickly as possible.

It says: “Providing that PCNs move forward swiftly to engage new staff and use their additional roles reimbursement entitlement, there will be significant additional capacity within primary care in 2020-21 to deliver the specifications.”

If they do as planned, it says, the arrangements will “provide more than sufficient capacity to deliver the requirements across all five services with significant capacity remaining for these additional roles to provide wider support to GP workforce pressures”.

However, PCNs have struggled to bring in the additional workforce available in the current network contract, particularly new clinical pharmacists which will be key to delivering the structured medicine reviews.

While some PCNs have been hard-pressed to find additional workforce, community health providers and others, such as ambulance trusts, have been concerned they will see their clinical staff leave to fill the new posts in primary care.

In an apparent move to ease this friction, NHSE’s draft guidance says it “will be asking [clinical commissioning groups] and [integrated care systems] to support PCNs and their community providers to institute shared workforce models that can help maximise collaboration between local partners to deliver the specifications and build the wider PCN”.

NHS England suggests this could include:

• “Running shared recruitment processes across multiple PCNs”;
• “Potentially providing management support to PCNs to help them run recruitment processes”; or
• “Brokering integrated workforce arrangements with other providers, for example through rotational posts”.

NHSE has asked for feedback on the draft, which it has said will inform negotiation with the British Medical Association on a final version of the specifications, which it plans to conclude “early” in 2020.