presentation from the Norfolk STP Primary Care Programme meeting

1. Delivering primary care
networks (draft)
PCC Workstream Board – 12 February 2019

2. • The NHS Long Term Plan (LTP) mandates a fundamental redesign of patient care to future
proof the NHS for the decade ahead matched with over £20billion of new money over the
next five years
• The achievement of the transformations set out in the plan requires CCGs to work with
Councils together with other key stakeholders in Integrated Care Systems(ICSs)which will
replace STPs on current footprints throughout England from April 2021
• The LTP sets out a new service model for primary and community health and care services
based on Primary Care Networks (PCNs) that must be in place throughout England
operating from July 2019. These PCNs will be the foundations for the new ICSs
• STPs must formally set out their Strategy for PCNs for NHSE approval as part of the STP
system strategy by the Autumn of 2019
The NHS Long Term Plan

3. PCN Strategy Development
We now have clear guidance on the requirements being placed on General Practice
through Primary Care Networks set out in the BMA/NHSE publications Focus on
Primary Care and Investment and Evolution five year framework. These documents
set out specific deliverables expected of general practice in PCNs linked to the
transformations in the LTP together with a five year high level plan and funding
programme
To develop our PCN strategy we need to develop an equivalent plan and programme
for the community based services that will be required to support people in their
homes, care homes and other community settings.
As a system therefore we need to develop a five year community services plan that
compliments the plan for general practice as part of our overall PCN Strategy
required by Autumn 2019

4. • Through our AICS programme and our primary and community workstream, we have been
working with GPPOs and practices to develop more integrated models of care in order to
improve health outcomes
• At system level we have developed together a single strategic approach for the
commissioning of primary care, which is overseen by the primary and community
workstream. Our GPPOs have come together to consider how they can work together
both strategically and operationally
• At place level, we have created five local delivery groups which provide the operational
support and local delivery of the single strategic approach, whilst also being locally
sensitive. Each place has a GPPO in place with most practices forming part of their
membership
• At neighbourhood level, we have created 20 primary care networks as the foundation of
developing integrated models of care locally with each practice understanding which PCN
they form part of
Developing the PCNs -1/5

5. Developing the PCNs – 2/5

6. Developing the PCNs– 3/5
• The publication of the LTP formalising PCNs, leadership from the GPPOs and the detailed
proposals for developing PCNs supported by a new five-year contract agreement between
NHS England and the General Practitioners Committee has led to a change in thinking from
general practice about how they can now work together to improve both their resilience
and sustainability, and also to improve patient care and outcomes
• This seems to be the first time that a negotiated deal has been welcomed by both NHSE
and GPC, and it is backed by substantial investment nationally in general practice and
primary care networks plus substantial ongoing investment from CCGs
• There is a strong signal that CCGs will go over and above this investment as well as
continuing any existing cash and resource in kind investments
• There is also an expectation nationally that community-based providers will reconfigure
their services around primary care networks and this will be reflected in a network
agreement

7. Developing the PCNs – 4/5
PCNs will be the driving force behind:
• Improving the quality of community based care by leveraging and deploying multi
disciplinary person centred services
• Improving the experience of care through person centred multi disciplinary urgent
response and reablement teams
• Improving the quality and experience of care in our care homes through the roll out of
the EHCH programme
• The redesign of services to support people in the community with specific physical and
mental health conditions reducing avoidable admissions to our hospitals
• The redesign of community based services needed to optimise timely discharge from
our hospitals
• Breaking down organisational and professional boundaries
• Tackling inequalities in access and experience of care
• Preventative care and wellbeing services

8. Developing the PCNs – 5/5
The N&W system will need to ensure that there is adequate system level support
to enable the PCNs to develop rapidly and achieve the challenging targets set out
in the LTP.
As well as programme management and implementation support the system must
ensure that:
• PCNs are provided with a Population Health Management service to enable
segmentation, risk stratification, case finding and preventative strategies to be
developed and implemented to drive and transform service delivery
• PCNs are supported to develop and implement both primary and community
based care Workforce Strategies
• PCNs are supported to develop and implement the Digital agenda

9. The national timetable
• Between now and May, PCNs will work together to prepare for meeting
registration requirements, including agreeing the basis of their network agreement
• By 31 March, NHSE and GPC will publish the national template network agreement
and the GP directed enhanced service which will fund practices’ participation in
the PCN
• By 15 May, each PCN must have applied to the CCG to register itself with the full
agreement of constituent practices, its nominated payee for PCN funding, its initial
network agreement and its clinical director
• By 31 May, each CCG must approve all applications at the same time to ensure
there are no gaps in coverage and PCNs are contiguous
• 1 July PCNs go live and funding investment begins
• By the autumn, the STP will publish a primary care strategy as part of our wider
system strategy

10. What’s new
• A new role of clinical director for each PCN, which is expected to be a GP. This will be
a key role, supported by a national template job description and funded at 0.25 WTE
• Clinical directors will form a key part of ICS and place-based leadership, providing the
voice of general practice and improving the ability for other providers to engage with
general practice
• The new network agreement will enable general practice and community-based
providers in a neighbourhood area to formally agree the basis of how they will
integrate services
• A new additional roles reimbursement scheme for PCNs will start in 2019/20 by
funding a clinical pharmacist and social prescribing link worker for each PCN and
investment will grow over five years
• The social prescribing investment will support links with social prescribing schemes
provided across Norfolk and Waveney by Norfolk and Suffolk County Councils

11. Investing in our PCNs
• The primary and community workstream has agreed with GPPOs how the £535k bid
funding will be used to support delivery of PCNs in line with our existing bid and this
new contract framework
• CCGs must make available £1.50 per head which will be invested in the new PCN
agreement from 1 July. We believe there is some flexibility on this in the first quarter
of 2019/20
• The GPPOs have asked for a single strategic approach from CCGs to this investment
• GPPOs are in an ideal position to work with practices in each PCN to support
development of the initial network agreement and identify clinical directors. This will
be particularly important in situations where practices haven’t traditionally worked
together, where there are relationship issues between practices or where practices in
a particular network are experiencing resilience issues and don’t have capacity

12. Investing in our PCN development
Dates Milestone
By 31 March 2019 Agreed approach to £535k with GPPOs – explicitly targeted to delivering 20
PCN plans and early engagement with practices in line with contract framework
Opportunity to steer towards meeting national requirements by 1 July
£100k NHSE investment in developing GPPOs
£100k NHSE resilience funding to supporting development of PCNs (North and
South leading)
Continuation of our STP GPFV workforce schemes
From 1 April 2019 CCGs to make available £1.50 per head to develop PCNs
From 1 July 2019 CCGs £1.50 per head becomes part of PCN network support
NHSE to make available 0.25WTE per 50k PCN for clinical director
Expected total of £2.01 per head (£2.19 from 2020) and expectation CCGs will
go further
Network engagement payment directly to practices – amount and details TBC
£1.45 per patient for extended access DES

13. • GPPOs hold key role in engaging and supporting general practice to form PCNs,
finalise network agreements and appoint clinical directors
• Our £535k bid set out how GPPOs would develop PCNs including delivery of 20
high level PCN plans by March 2019, this can now be expanded to meet
requirements of new national guidance
• PCNs must nominate a single provider for receiving PCN investment and
employing shared staff – GPPOs can support
• Clinical directors may not need to be from a PCN practice – further details may
come nationally and GPPOs can support this process. PCNs may have a shared
clinical director
Progressing development of our PCNs – 1/3

14. Progressing development of our PCNs – 2/3
• Clear guidance for community provider organisations to reconfigure services
around PCNs, this may include clinical and managerial staff
• Clear statements around CCGs supporting PCN development both in cash and
support in kind. We should develop consistent offer across CCGs
• Our mental health strategy commits to the colocation of services with primary
care networks, this work is interdependent with the primary and community
workstream
• Our social care colleagues are committed to reconfiguring services to integrate
with primary care networks

15. Progressing development of our PCNs – 3/3
The scope of community based services is vast and is delivered by multiple organisations, groups
and even individual carers.
Community based services need to develop alongside primary care and include:
• Physical and mental health services delivered by the NHS providers (NSFT, NCHC and ECCH)
• Social work, occupational therapy assessment, emergency response, support activities and
preventative services including public health and reablement delivered directly by two County
Councils (Norfolk and Suffolk County Councils)
• Residential and nursing care, home care, care in supported accommodation and day services
provided by hundreds of independent businesses commissioned by NCC/SCC and CCGs worth
more than £400m every year
• Housing, leisure and wellbeing services provided by the 8 district councils
• Support services provided by the voluntary and community sector

16. Developing community based services alongside primary care – 1/4
NHS community providers and councils were developing integrated approaches before the LTP providing
a foundation upon which to build. The new framework however requires these organisations to revisit
their plans and rapidly develop them to support the fundamental redesign of patient care through the
new PCN model of care.
These organisations now need to set out high level plans and principles of service transformation to
mesh in with the developments in primary care over the next few months in time for the PCNs going live
on 1 July. These plans will need to be further refined for incorporation into the PCN Strategy required by
September 2019 from all systems in England. The strategy will need to set out our ambitions for
improving population health and wellbeing and how we will achieve those ambitions over the next five
years
At the same time we need to ensure that other providers including the VCS, unpaid carers and service
users are meaningfully involved throughout the process. System level support will be required to ensure
we have the capacity to support coproduction and codevelopment of our strategy

17. Developing community based services alongside primary care – 2/4
Key principles and assumptions
• People want care closer to home focussed around primary care
• Health and care staff prefer to work in teams making best use of multiple skills linked
strongly to local populations in a place
• Care should be personalised and designed around the person needing it
• A consistent approach across the system with variation to reflect local variation
• Involvement of people and stakeholders throughout the development of PCNs
• Evidence driven development of services based on consistent population health data
and analysis
• Focus on people’s health and wellbeing and what works and matters to them rather
than organisations
• Transparent sharing and roll out of good practice wherever we see it in the system

18. Developing community based services alongside primary care – 3/4
Next Steps
Dates Milestone
By 1 May 2019 • Develop and agree a common community services maturity framework based on
the national PCN framework setting out the key LTP deliverables and ambitions for
multi disciplinary cross organisational working including but not limited to 2 hour
urgent response MDTs and 2 day referral reablement services
• Carry out an initial assessment against the framework and develop clear plans to
achieve full alignment by 1 April 2021
• Success indicators and key metrics agreed to enable assessment of progress
through dashboards
By 1 June 2019 • Draft proposals for how community providers will work with PCNs codeveloped for
each Place
From 1 July 2019 • New ways of working begin developed from progress already made

19. Developing community based services alongside primary care – 4/4
Examples of deliverables in the first two years likely to include:
• Multi disciplinary community led urgent response (2hour)
• Reablement available (multi-disciplinary) (2 days)
• Meaningful standardised MDT meetings/huddles and practices knowing who their teams are including
any link workers
• Joint prioritisation and targeted allocation of work(eg OT)
• Co-location of staff as far as possible
• Community hubs
• Teams will include mental health workers -both working age and older people as core members
• Enhanced Care home Services
• Joint care planning and joint care plan recording
• Alignment with 3 acute systems (East, West and Central)
• Services to prevent un necessary admissions and support early discharge
• Consideration of a single operational lead role in PCNs at Place level
• Some budget alignment

20. Primary Care
Networks
Family
Prevention
Local Community
Services
Carers
ongoing response
GP cluster