Apr 4, 20225 min read

The 2022/23 Network Contract Directed Enhanced Service Update

Updated: Oct 25, 2022

AKA The 2022/23 Primary Care Network (PCN) DES Update

What to focus on in Q1

As always, I write these updates with new PCN Managers and Clinical Directors in mind.

By new, I mean less than 9 months in post or you may have more than 9 months PCN Management experience but have joined a new network and need reminding of the fundamentals.

The 2022/23 Network Contract Directed Enhanced Service Update was released on 31st March and updated in September 2022. These are my initial thoughts.

Getting started | How I read the DES

When I approach reading the PCN DES updates, I will first go to:

The NHS Confederation via their Primary Care Hub App for their summary. They are always quick off the mark and have summarised all of the key dates the guidance contains. The Confed summary lets me know:

What will need my attention in Q1
What I need to start strategically planning
What I need to be mindful of but not stress about

Details on how to join the NHS Confederation can be found here.

I also reviewed our latest THC update, which in this case was the Spring Update we published on 8th March. This gave us a heads-up on what was coming relating to funding, extended access and the Impact and Investment Fund.

I will also head over to EGP learning and Ockham Health, as they usually produce excellent updates relating to Primary Care Networks.

I like to source a few viewpoints on this important document, but it’s crucial you also develop your own thoughts on this strategic document and can critically appraise and decide on the next steps of your network.

I then like to print the document off and put it in a folder. For me, the PCN DES is an essential document that I refer to all of the time, so having it printed off and on my desk at all times is really helpful. I also have it on my desktop computer, along with a copy of the Impact and Investment Fund Indicators. You do what works for you.

This document is 134 pages, but don’t worry, it’s a well-written specification and not a book you need to read cover to cover or in one go. Also, a big chunk of the document is job descriptions which inform the DES requirements, but your network will already have a lot of roles in place, so work with your management team to help understand the network's portfolio to date.

What do I need to focus on now?

Enhanced Access

Because the NHS Confederation has presented the timeline, and as a member, I get to observe the conversations taking place, I know extended access is a significant piece of work for me to get up to speed on.

Whilst the ‘go live’ for this increased service (inclusive of weekend provision), commences on 1st October, a lot of planning needs to take place, and I will need to further my understanding of the network's position on this.

Governance Review

As a new manager or CD, the network agreement will be an important document to review and update.

Listen to the podcast I recorded with Dr Claire Sieber, mediation specialist for further insights on the importance of the network agreement.

LISTEN HERE

Developing and delivering local improvement pathways and workforce strategy and execution

In my view, these activities are intertwined, as ideally, we would first work out what we need to do to enhance the care to our population, alongside reducing the stress and often unmanageable workload on the current workforce. To inform our workforce strategy, I would want to ensure we:

Include the general practice workforce gaps and not just the PCN additional roles we can recruit to
Work in partnership with our population and wider stakeholders
Are using information systems like Ardens or Apex, or an equivalent to better understand our population’s health

The role of the Clinical Director

The document includes the role of the Primary Care Network Clinical Director. If you are a new CD, check out page 21.

If you are a PCN Manager, review this section to better understand how your role complements and integrates with the CD. Also, check out the blog, What Does a PCN Manager Do?

Business as usual services and activities

The next step would be to understand the business as usual activities.

The vaccination programme – (If you are still delivering this)
Extended Access, which will move into Enhanced Access from 1st October
Social Prescribing
Enhanced Care in Care Homes
Cardiovascular Disease (CVD)
Medication reviews and medicines optimisation - formally listed as Structured Medication Reviews
Early Cancer Diagnosis (ECD)
Tackling Neighbourhood Health Inequalities – This is new
Delivering on the Impact and Investment Fund - This is being reintroduced
Monitoring network performance
Recruitment
Stakeholder management

Local contracts and projects PCN are also delivering on:

Local development plans
Practice Incentive Program (PIP)
Local Incentive Schemes (LIS)
Enhanced Services (ES)

What you will need to ascertain is;

Who is leading in what?
What is working well?
What requires your attention?

A simple DES tracker will support you with this in the form of an excel spreadsheet, which in one column, will list the requirements and then, in other columns, provide space for a progress update. We provide for this in our PCN Accelerators Programme

The key timelines

Below are some of the key timelines we will need to work towards with some things to consider.

This timeline will inform you what you need to work on now and what can wait.

	Pg	Initial deadline	Service goes live	Things to consider
Submit Enhanced Access plan to commissioners	46	31st July 2022	1st October 2022	Who is our PCN extended access lead? What do we want? What is currently working well? What needs improving? How will we engage our patients in this? Who and what do we need to make this successful?
Commissioners must agree and the Enhanced Access Plan with PCNs	46	31st August 2022	1st October 2022	What does our comms strategy look like and what management resource is going to be dedicated to this to ensure a smooth go-live rollout on 31st October?
Data sharing and processing arrangements start Enhanced Access delivery must be in place	46		1st October 2022	This will require a review of the current arrangement and advice from your Data Protection Officer (DPO).
Extended Access goes live	46		1st October 2022	Expect some teething problems if creating a whole new service, but as planning for this is started in March, all will be fine.
Commissioners must agree an estimate of unclaimed ARRS funding for 22/23	41	31st August 2022		If you have a track record of using all your ARRS funding allocation, pay close attention to this opportunity. Whilst direct recruitment may be challenging, providers of clinical services, for example, FCPs, pharmacists, and SPLW may be able to ramp up the services to serve you and your population.
All PCN staff must complete refresher training for Shared Decision Making	63	30th September 2022		I would task a care coordinator with this action.
Personalised Care Design must be complete	63	30th September 2022	On 1st October Delivery of a proactive social prescribing service for an identified cohort	Ideally, you have a clinical lead which is not the CD supporting this element in partnership with your social prescribing team.
Personalised care review must be complete along with shared decision-making audits	62		31st March 2023	This is important but this would not be my focus in Q1. This will inform our plans for Q2.
A PCN must contribute to the development of ICS Anticipatory Care design	61	Late 2022	Late 2022	This is important but this would not be my focus in Q1. This will inform our plans for Q2.

Summary

Here is a plan of action for you to modify and meet your network needs.

Discuss the PCN DES with your Clinical Director and Management teams
Update /make a DES and workstream tracker to ensure we have all of the requirements easily to hand and to assess how the network is performing against these
Review or set in motion your approach to creating a robust workforce strategy
Ensure the PCN either has a seat in the extended access steering group or if we need to form one
Ensure the PCN is aware of the IFF indicators and updates
Meet with the PCN finance lead to ensure they are aware of what funds will be coming to the network. This can be found on page 71 in the DES
Update and work to a 90-day plan

If you would like a guide on how to present the latest updates to your network, check out our free slide deck here.

Final thoughts

There is a lot to do, and it can be overwhelming BUT, it's also hugely exciting.

This is a job not to be done alone. You need a team around you and need to stay in close communication with them and the wider network. Effective communication and honesty are key.

Work in partnership with others and share your ideas, and I’m sure they will help because our networks are all so different. What may seem obvious to you will inspire others to do things differently.

As my thoughts and approaches evolve, I will be sure to share these with you.

DISCLAIMER: We endeavour to keep our blogs up to date and the information presented reflects our knowledge at the time of publishing.

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Tara provides project and network management and training to Primary Care Networks, coaching support to clinical leads and has worked with 11 Training Hubs and 19 Primary Care Networks to date.

Tara has an MBA in Healthcare Leadership and Management, is published in the London Journal of Primary Care, is the author of over 200 blogs also hosts The Business of Healthcare Podcast.

Find out more about THC Primary Care at www.thcprimarycare.co.uk

And follow Tara on Twitter @THCPrimarycare