- Four providers are filling the banker role for four primary care networks in England
- Most networks have opted to have a member practice as their nominated payee
Four NHS trusts have established a foothold in primary care networks, HSJ can reveal.
PCNs – the new groupings of GP practices central to the NHS long-term plan – must all choose an organisation to manage funding and employ the substantial additional staff they are due to take on in coming years. They can choose either one of their own member GP practices, a GP federation or “voluntary sector organisation”, or an NHS trust or foundation trust.
HSJ analysis has discovered that four NHS provider trusts which are directly or obliquely filling this role – often known as their “banker” but officially referred to as the “nominated payee”.
These four trusts – Humber, Yeovil District Hospital, Southern Health and Royal Wolverhampton – already run, or jointly run, general practice services in their area, under existing arrangements.
The payee receives funds from NHS England and local commissioners on behalf of the network, dispersing the money to pay practices for participating, providing services, and for salaries of network workforce. It is also envisaged that they will often employ the staff.
HSJ used freedom of information requests to obtain information for 1,222 PCNs – 37 short of the 1,259 NHS England stated had been formed as of 1 July. However, clinical commissioning groups were only willing to divulge the identity of the nominated payee for 909 of them – the other 313 were withheld either because the CCG claimed it did not hold the information or that it was exempt from release.
Three-quarters of the 909 – 688 networks – had selected one of their member practices as the nominated payee. Of these, 27 are single-practice networks – made up of only a single practice. Many of these are large practice groups, such as Hereford Practice Group, with more than 47,500 patients over eight sites in and around Hereford.
The only other sizeable group was GP federations and similar organisations (like GP confederations or alliances) with 207 (23 per cent).
Policymakers have said building links between GP and community health services is an important priority for networks. They have also stressed that for trusts providing community services, taking on the PCN payee/employer role would represent a strong formal connection.
The relatively small number of trusts acting as “bankers” may be due in part to how quickly PCNs were established early this year, and to national payment systems – which mean it is difficult to choose a “nominated payee” which does not already have a primary care contract, meaning it is on the NHS primary care payment system.
NHS England has said it is looking to relax this restriction for 2020-21, while PCNs will also be expected to employ more staff – which could mean more networks pick a trust as their nominee.
The four trusts which HSJ has identified with a strong link to PCNs are:
1. Humber FT, a mental health and community trust which runs seven GPs in the Hull area, having set up a company – Humber Primary Care Ltd – to hold the primary care contracts. The trust is the nominated payee for the Harthill network of eight GP practices in the East Riding of Yorkshire, near Hull. Four of the FT’s practices are part of this network with the remaining three in other nearby PCNs.
2. Yeovil FT, a small acute trust which runs nine practices through its wholly-owned corporate entity, Symphonie Health Services Ltd. The firm holds the contracts with NHS England for their primary care services. Symphonie is the nominated payee for one network made up of four of its practices.
Another of its practices, Oaklands Surgery in Yeovil, is the nominated payee for a second network – Yeovil PCN – although it is not clear how far Symphonie is fulfilling this function. The remaining four Symphonie practices are in separate networks.
3. Southern Health FT, a mental health and community provider, which took over running four struggling practices in Gosport in 2016 and 2017, which were then merged into a single group, the Willow Group, with GPs working for the FT under an employed model. The Willow Group has a combined list of more than 35,000, and operates as a single-practice PCN.
4. The Royal Wolverhampton Trust, in addition to acute and community services, runs nine GP surgeries through a vertical integration model whereby the GPs maintain their contracts with NHS England but are employees of the trust. RWT’s GPs make up a single network together, with one of the practices filling the nominated payee role.
Subscribers to HSJ Intelligence will soon be able to read the full details of HSJ’s analysis of the emerging PCN sector, including details of every PCN, a regional breakdown and the crucial role of super-partnerships
Information provided to HSJ
July to October 2019
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Revealed: The NHS trusts acting as PCN "bankers"