The revised Network Contract Directed Enhanced Service (DES) encompasses several changes that can be hard to understand. We’ve done our best to clearly lay out what some of this new funding means for Primary Care Networks (PCNs) and how they can unlock more of this funding with service design support and digital triage.
Crucial to maximising this funding is how you workflow demand, and in particular online consultations, across the PCN and distribute them to the most appropriately skilled roles. Moving to a model where you process and triage incoming patient demand in one place is the easiest way to create efficiency across your PCN.
There’s an urgent need for PCNs to have a plan ready to submit to their CCG or ICB before the 31st of July 2022 so that they can begin the process of receiving the Enhanced Access funding for October 2022. Make sure to use the NHS’s Ready Reckoner financial spreadsheet to plug in your PCN’s details and see how much money could be available to you.
PCN funding explained: How to unlock the funding and plan for your PCN’s future
Watch our on-demand webinar to have the PCN DES explained to you. Hear from Folkestone, Hythe & Rural PCN’s Clinical Director and Digital Transformation Manager about how their PCN is planning to maximise the funding available. We’ll also be talking through the benefits of centralised working with an eHub.
What is the extra funding?
We’ve pulled out the key funding sources that you need to be aware of and why they’re important for you.
Additional Roles Reimbursement Scheme
This is your possible recruitment pot, details which are in the Ready Reckoner for your PCN – you can only draw on this money for the successful recruitment of any of the 15 possible ARRS roles (Annex B), as needed by the PCN.
To maximise the use of ARRS roles, PCNs should look at their incoming demand and map which types of conditions or presenting problems can be handled by these different roles (at least in the first instance). For example, First Contact Physiotherapists could handle back, leg, shoulder or knee problems and Mental Health Practitioners can handle certain mental health problems.
It is also helpful to embed any care navigation guidance with front-line administrative teams and clinicians to maximise awareness and utilisation of ARRS roles. Having consistent and auditable data about how your demand breaks down will be critical to this mapping. This is where having a lot of your incoming requests online can provide consistency and rich data.
If you’re an eConsult customer get in touch and we can help your PCN with understanding your inbound online consultation demand data and how to map these to ARRS roles.
Enhanced Access Payment
This payment combines two previous yearly funding streams into one: the £1.44 per head Network Contract DES Extended Hours Access funding and the £6 per head CCG-commissioned extended access services.
From October 2022 this will become one funding pot of £7.44 per patient, relabelled as the Enhanced Access Payment. It’s paid out based on your PCN-adjusted population and will be prorated for the rest of this year (£3.764 multiplied by the PCN’s Adjusted Population from 1st October 2022 to 31st March 2023).
That’s a massive increase of 417% available to PCNs – as long as they follow the new stipulations for extended hours (Section 8). It’s also important to note that if your PCN decides not to opt-in to the new Enhanced Access Payment, they will not only miss out on this increase in funding, but they will also lose the £1.44 available to them, as this will cease to exist on the 1st October 2022.
Impact and Investment Fund (IIF)
This additional funding gives PCNs ‘points’ based on performance against key indicators. There are a maximum of 1,153 IIF points – with each point approximately equivalent to £200 (adjusted to list size and prevalence). This could equate to an additional £4.22 per registered patient. Some indicators of relevance include (Annex D):
- The number of online consultation submissions received by the PCN per registered patient. Worth 18 points, there is a requirement for 5 online consultations per 1,000 patients across the PCN, but this could yield a value of around £3,600.
- The number of referrals to the Community Pharmacist Consultation Service per registered patient. Worth 27 points and a value of approximately £5,400. Requirement of 0.65 CPCS referrals per 1,000 patients across PCN.
- Percentage of patients whose time from booking to an appointment was two weeks or less – worth 71 points with a value of around £14,200. Appointment categories can be telephone, online and face-to-face. Clinical triage as a slot type is now a nationally recognised appointment category.
PCN Leadership and Management Payment:
This payment of £0.699 per patient was introduced in last year’s Network DES contract but only started to appear in PCN payments during the end of the 2021 calendar year. This could be earmarked, for example, for change management support for PCNs or recruiting into transformation roles that can support PCN Development.
In our opinion it is imperative for PCNs to consider factoring in change management support, particularly when designing new pathways, increasing online consultation utilisation and developing PCN eHubs.
What is the implication of the funding?
The biggest change in the contract is the Enhanced Access Payment – this gives PCNs a substantial pot of money to spend in providing additional appointment capacity outside of ‘core hours’ and within the new ‘Network Hours’.
This is where PCN Clinical Directors need to think smart about how they can combine efficient service design and maximum utilisation of staff skill mix to manage demand and fully exploit this funding. Whilst a reasonable proportion of appointment capacity needs to be face-to-face, the remainder can be remote via online and telephone consultations.
PCNs can achieve the contractual requirements set out in the Extended Access contract in a cost-efficient manner, using online consultations to support intelligent triaging of demand and use of the wider workforce. Depending on the maturity of the PCN, this planning and strategy work can be quite daunting, particularly when tight deadlines are approaching.
It’s worth checking with your local CCG on what transformation support may be available to PCNs including access to PCN Development funds. Here at eConsult, our experienced transformation team can also support you – just reach out to us!
How can PCNs maximise this funding?
Maximising your skill mix to manage demand
The combined uplift in funding from both the ARRS and Extended Access Payments is the perfect opportunity to think about how to alleviate the work currently allocated to GPs in individual surgeries and instead maximise the work that ARRS roles can pick up.
By broadening your skill mix at the PCN level you are also optimising the use of your ARRS roles to support the delivery of additional appointments set out in your contractual arrangements. Encouraging online consultations will not only support IIF targets but can help identify which patients can be better served by ARRS roles.
Centralise online consultation processing
Centralising your processing of incoming patient demand is the easiest way to create efficiency across your PCN. In particular, this can be done by encouraging patients to shift to online consultations, where the onus is on patients to spend time providing information about their needs and symptoms.
Additional capacity can be created by leaving individual practices to manage their own administrative requests (about 30% of incoming online consultations or eConsults) and pooling clinical eConsults at your consultation processing hub (or as we call it, an eHub). This can introduce cost savings for practices by placing less burden on individual practices, reducing the need for locums or salaried GP spending.
It also allows practices to focus their clinical time on the cases that are triaged by the eHub, or to focus on patients that need complex care or continuity of care.
Setting up online consultation eHubs: Learnings from their creator
Watch our on-demand webinar to find out more about centralised online consultation processing through eHubs. Hear from their creator, Dr Ross Dyer-Smith about some of the challenges he faced while coming up with his eHub back in 2017 and the multitude of factors to consider when setting one up yourself.
How can eConsult help you to maximise this funding?
For some PCN Clinical Directors, much of the thinking required for service design and workforce planning needed to set up super efficient at-scale working will be relatively new to them, considering PCNs are still in their infancy. Some Directors may be more used to thinking about service delivery from the perspective of a single practice or may not have access to suitable resources for change management on a wider scale.
As pioneers of the eHub model, we have over 5 years of expertise in setting up and running eHubs and experience in supporting the deployment of eHubs across the UK.
We can help you set up and configure an eHub based on your needs: we have in-house clinical and transformation consultancy expertise in eHub implementation and clinical system redesign. We offer a fully structured transformation and change management programme to help you evolve your ways of working, update your SOPs and identify skill gaps and build team capability and confidence in digital triage and remote consultations.
Talk to our team to discuss your plans
Find out how to maximise your funding with a personalised consultation