These questions relate to the Primary Care Networks and the Network DES. To ask a question, please email firstname.lastname@example.org
Q1 – Our Network is developing a process for recruiting our Clinical Director. If we decide to interview candidates how can we ensure impartiality as all candidates will be connected to one of the practices?
A – In other areas a combination of support has been provided by the CCG, LMC and Federation. PCS would be happy to work as part of this arrangement to support the recruitment of your Clinical Director to act as a neutral panel member for the interviews for any Networks who require it and want PCS to contribute to the process.
Q2 – Please can PCS develop a more robust data sharing agreement that can be used across the city?
A – A National Data Sharing Agreement will be published by the 29th June. This is the agreement that Networks will need to use to support the DES. Following publication of the guidance PCS can offer support with completion and understanding the implications of its use and how it links to the Network DES.
Q3 – How do we avoid Networks competing with each other to attract the best staff for the additional roles in the NHS Long Term Plan and inadvertently inflating the costs of employing people in these roles?
A – The best way to approach this is for Networks across Sheffield to work towards developing a sustainable service and not just employing an individual. PCS have experience of doing this and currently provide clinical pharmacists to practices, a physio service and we are currently looking at how we develop a model of primary care mental health practitioners. This means that practices contract with PCS to provide a service rather than an individual. This helps to ensure a consistent level of service across the city; includes the infrastructure for appropriate clinical supervision and resilience. This model is one that can be replicated for the other roles and will prevent the risk of people ‘competing’ across Networks for similar roles.
Q4 – If our Network wanted PCS to be our Nominated Payee and receive the funds on behalf of all practices within our Network, who will administer the funds and payments?
A – PCS are able to hold the funds as the nominated payee. This does not make them the administrator for the DES as this would remain with the Network. In the first instance this would be a simple transaction to the Network from PCS but as the Network DES grows and becomes more complex the Networks may want to discuss who administers the DES. At this time PCS would be happy to explore this with any Network that wants to discuss this further and agree how this will be managed. For PCS to be the nominated payee (not the administrator) there is no fee.
Q5 – How do we avoid fragmentation and loss of influence on the system as we have made a lot of progress in establishing our Neighbourhood so far?
A – It is important that we don’t lose the progress and sense of collective efforts that we have achieved in Sheffield so far. Primary Care Networks are central to the development of neighbourhoods working with partners who have a focus on population health. Sometime ago PCS consulted with shareholders to update our Articles of Association with regards to establishing a Neighbourhood Committee of the Board. The articles were approved and changed. The purpose of this Committee is to provide a formal mechanism, which is designed to create coordination and improve influence for Neighbourhoods to develop local primary care services and to facilitate peer to peer communication and information sharing across the city. The Committee membership is anticipated to be Clinical Directors of each Network which will help provide improved system leadership and also give strategic direction to primary care at scale.
Q6 – Would PCS be in a position to provide the Extended Hours element of the contract that practices need to deliver?
A – If a practice or Network want to talk to PCS about support for the provision of extended hours as a result of signing up to the contract DES please contact email@example.com. We appreciate that each Network will be in a different position and therefore want to be flexible but supportive in how we respond to the Network needs. PCS are happy to offer support and explore direct provision for any gaps in hours with the Networks on an individual basis.
Q7. There are different interpretations of Extended Hours currently across the city, though the national guidance and requirements of the Network DES include it. Do you think this will become more consistent in the future?
A – How a Network meets the Extended Hours requirements may vary between the practices who make up that Network, however the service available to patients in their population should become more consistent.
Q8. Are emergency appointments included in the Extended Hours DES? Do we have to change how we use the Extended Access Hubs?
A – For the Extended Hours DES it does not appear that the requirements have changed and appointments are for pre-bookable access only. Currently the Extended Access does provide a proportion of same day urgent access appointments through the practices, the GP Collaborative or 111 (the latter at weekends and Bank Holidays only). For the Extended Access Hubs the national guidance on the Network DES contract specification aims to ensure that primary care provision is consistent across the country. It doesn’t take into account the current structures and services which are already in place in some areas and not others. In Sheffield our Extended Access Hubs are well established and already providing evening, weekend and Bank Holiday appointments. PCS is keen to support Networks in developing their plans for Extended Hours and Extended Access
Q9. When can Networks begin recruiting to the additional roles included in the contract specification?
A – Now. Practices have to provide information for a baseline assessment of workforce up to 31st March 2019 through the National Workforce Reporting System (NWRS). Practices are not able to receive funding for the additional roles for staff who were already in post by this date (with the exception of the clinical pharmacists where a practice has been participating in the national programme), as the roles must be in addition to the current workforce. As a city we should proceed as soon as we can in order to gain the maximum funding available.
Q10. Do PCS plan to employ staff in the other additional roles (e.g. Social Prescribing Link Workers, Paramedics and Physician Associates) on behalf of Networks, in a similar way to the current Clinical Pharmacy and Physio Service?
A – Yes PCS are happy to look at the additional roles and providing support to Networks through developing a service if this is what Networks want. PCS will work with the Networks to ensure this meets their need. The roles we are currently exploring are the Pharmacist and Social Prescriber. The Social Prescribing needs to be managed carefully given all the positive work that is happening across the city currently and Networks need to decide how they want this role and service to work, building on the positive models that have already been established. PCS are working with other system partners to understand what the introduction of this new role will mean for the wider system and will ensure everything is fed back to Networks as the discussions progress. Any Networks who would like to discuss their needs further then please get in touch.
Q11. What are the advantages to Networks of PCS employing the additional staff on their behalf?
A – Through the existing Clinical Pharmacists in General Practice programme we have developed an effective, scaled workforce model and the infrastructure and governance for employment and deployment across the city. Our model incorporates support and development, mentorship and supervision, with the added benefits of avoiding artificially inflating salaries through competition for the same pool of staff, safeguarding and developing a workforce for the future in the city, and ensuring a consistent level of service to practices and their patients that provides cover for annual leave, sickness and other absence.
Q12. What plans do PCS have for Social Prescribing Link Workers?
A – We are currently working with partners in the city to explore how social prescribers, community support workers and other link workers are best utilised and supported as a valued workforce going forward. We are holding a joint Neighbourhood Learning Network event on 16 May with Practices, Council and voluntary and community sector organisations to share ideas and shape the city’s approach.
Q13. Can the role of a Clinical Director be a job share?
A – The national guidance allows this and also suggests that Networks may wish to consider appointing for a fixed term to allow rotation. The demands on the Clinical Director are likely to increase over time, especially the need for management support. The Neighbourhood subcommittee of the PCS Board will provide an important support and communications network for Clinical Directors. We hope to form this subcommittee as soon as Networks have appointed. We are also developing a model of supportive training and development, including a provision for learning sets for named managerial leads across the city.
Q14. Will PCS charge a levy to Practices in order to provide support and the resource for it?
A – This is not something we are considering at this stage. We want to be there as a supportive resource for our shareholding practices and are not seeking to make a profit. Where we are providing a service or incurring costs we will need to consider charging but we will always seek to do this fairly, transparently and at the lowest possible cost to practices.
Q15. Will PCS share their expertise in planning the delivery of Extended Hours with Networks?
A – Yes, we are happy to provide support in exploring options.
Q16. Is there a legal definition of the role of a Clinical Director and the responsibilities and liabilities involved?
A – The guidance includes information on the key responsibilities of the Network Clinical Director, along with a clear job description. PCS have developed a template job description that Networks can use and this is available on the PCN Resources page.
Q17. Is a Network the same as a Neighbourhood?
A – No. A Network is the group of practices that come together and sit within the Neighbourhood. A Neighbourhood is a broader group of stakeholders who work collaboratively and seek to improve population health e.g. Social Care, Voluntary Sector, Mental Health.
Q18. Can a Clinical Director serve several Networks?
A – The Clinical Director must be appointed from a Practice within the Network and cannot work across multiple Networks.
Q19. If all Practices decide to open additional hours to meet the Extended Hours requirements, might this destabilise the GP collaborative?
A – The Extended Hours requirements set out in the Network Contract DES are contractual obligations that the Network must meet. Reviews of urgent care provision as a whole within the city will need to take into account the impact of new models of primary care that result from the new contract.
Q20. How will pathways be impacted by differing service models at Practice, Network and city level?
A – Much of the details of the Network contract DES are still to be worked through, and as time goes on this will be something that needs to managed carefully to avoid fragmentation and ensure equity of access to services for patients.
Q21. Is there concern that Practices are being pushed to form super practices?
A – Nationally we are being told that this isn’t part of the agenda and Networks will be an entity in their own right. Provision of primary care at scale is recognised but this is not the same as a super practice.
Q22. Does a Network have the final say over which Practices join it?
A – The structure of a Network is largely for Practices to determine, working within the rules of geographical contiguity and size in the contract specification. The exception to this rule is that the CCG has to ensure that there is 100% coverage across the city. Between the 15th May (when Networks submit their registration forms) and 31st May when CCGs are required to provide approval, any gaps or issues will be identified and discussed with the relevant practices and the LMC.
Q23. Is the requirement for a Clinical Director per practice or per Network?
A – The requirement is per Network. The role can be a job share however to share responsibility across more than one person if this is what the Network want to do. Some Networks are choosing to do this. The Clinical Director must be a clinician, but does not have to be a GP.
Q24. Do Networks have to complete the Appendix A (schedule 1) section and return this to the CCG with the Network Registration form by 15th May?
A – Advice from the NAPC and CCG is that a Network only has to complete this section if they already have an agreement in place. In some areas of the country, Practices have been working together as a Primary Care Home and so have established their governance structures and operating processes. This section will be required for all Networks by 30th June – as this is the basis of the Network Agreement. PCS plan to hold a series of meetings on the Network Agreement towards the end of May. PCS have developed a template Schedule 1 if Networks want to complete and submit this.
Q25. If a Clinical Director is accountable to their Network, what authority will they have over any Practices who aren’t compliant with meeting the performance indicators?
A – When you develop your Network Agreement you will need to include details of decision making, governance and collaboration arrangements and processes. This is therefore an area that you may want to discuss and agree as a Network at the start. Practices within a Network should be accountable to each other, as they will have joint requirements for performance. The national guidance advises Networks to seek advice from their LMC in terms of guidance and support where this is not working and also the CCG.
Q26. Do the Extended Hours in the specification have to be provided by GPs?
A – No, they can be provided by the extended clinical team.
Q27. Is the Clinical Director payment pensionable?
A – Our understanding is that this is pensionable but we would ask that you seek guidance from the LMC to clarify this matter.