Primary Care Networks (PCN)- what is expected from October 2021?
NHSEI have published their expectation for PCNs for 2021/22 and 2022/23. Full details of this can be found at the NHSEI web pages. This article aims to summarise these for practices so that you know what will be expected from October 2021 onwards. LMC plan to run a webinar about this provisionally on 16th September 2021.
NHSEI have identified five priorities for PCNs going forward
- Improving prevention and tackling health inequalities in the delivery of primary care
- Supporting better patient outcomes in the community through proactive primary care
- Supporting improved patient access to primary care services
- Delivering better outcomes for patients on medication
- Helping create a more sustainable NHS
To support these priorities NHSEI will invest £43m across England to fund PCN leadership and management development.
From April 2022 PCNs will be asked to provide a single unified extended access service, reducing the requirement for practices to provide this individually. Full details are going to be published later in the autumn.
PCN Service Specifications
Extra services which PCNs will be required to deliver have been postponed to recognise the post-pandemic workload.
The plan for introducing services is as follows
Expected from October 21
Expected from during 2022/23
Improving hypertension case finding and diagnosis
Increase diagnosis of atrial fibrillation, familial hypercholesteremia, and heart failure
Tackling neighbourhood health inequalities
Oct 2021- PCNs will be asked to identify and engage a population experiencing health inequalities within their area, and to codesign an intervention to address the unmet needs of this population. March 2022- start to deliver this intervention
Continue to deliver codesigned intervention
Deferred to 2022/23
By 30 September 2022, PCNs will be required to agree a plan for delivery of Anticipatory Care with their ICS and local partners with whom the service will be delivered jointly
Deferred to 2022/23
From April 2022 there will be three areas of focus for personalised care:
Some of the required activities are more suited to practice delivery, others are more suited to PCN-wide and cross-PCN delivery. The actions likely to be required from practices are as follows.
Improving hypertension diagnosis
This will include
- proactive review of historic patient records, to identify patients who have had a previous elevated blood pressure reading but have not had an appropriate diagnostic follow up.
- Undertake activity to improve coverage of blood pressure checks, by increasing opportunistic blood pressure testing where patients do not have a recently recorded reading
Improving Atrial Fibrillation identification
- opportunistic pulse checks alongside blood pressure checks undertaken in a clinical setting.
Improving identification of Familial Hypercholesterolaemia
- systematic searches of primary care records to identify those aged 30+ with Chol > 9mmol/L or with Chol > 7.5mmol/L aged less than 30.
- offer statin treatment to patients with a QRISK2&3 score >= 10%, where clinically appropriate
Tackling neighbourhood Health Inequalities
- Learning disabilities- Identify and add to register all patients with a learning disability and offer annual LD health check
- Serious Mental Illness- Identify and add to register all patients with a serious mental illness and offer annual SMI health check
- Ethnicity- record all patient’s ethnicity
- By 30 September 2022 all clinical staff must have completed the Personalised Care Institute’s 30-min e-learning refresher training for Shared Decision Making (SDM) conversations, available here
Investment and impact fund (IIF)
IIF will be worth £150m in 2021/22 and £225m in 2022/23. IIF is “QOF for PCNs” so practice-level achievement results in PCNs receiving the extra funding. How PCNs invest the IIF income will be decided by the PCN not the CCG/ICS.
IIF indicators which require practice actions
Details of all IIF indicators including thresholds for achievement are available in annex B of the NHSEI web pages. This is a summary of these indicators.
Improving prevention and tackling health inequalities
- Percentage of patients on the Learning Disability register aged 14 years or over, who received an annual Learning Disability Health Check and have a completed Health Action Plan
- Percentage of registered patients with a recording of ethnicity
- Percentage of patients aged 65 years or over who received a seasonal influenza vaccination between 1 September and 31 March
- Percentage of at-risk patients2 aged 18 to 64 years who received a seasonal influenza vaccination between 1 September and 31 March
- Percentage of patients aged two or three years on 31 August of the relevant financial year who received a seasonal influenza vaccination between 1 September and 31 March
- Percentage of patients aged 18 years or over, not on the QOF hypertension register as of 30 September 2021, and who have (i) a last recorded blood pressure reading in the two years prior to 1 October 2021 >= 140/90mmHg or (ii) a blood pressure reading >= 140/90mmHg on or after 1 October 2021, for whom there is evidence of clinically appropriate follow-up to confirm or exclude a diagnosis of hypertension by 31 March 20223
Support better patient outcomes in the community through proactive primary care
- Percentage of registered patients referred to social prescribing
Support improved patient access to primary care services
- Confirmation that all practices in the PCN have mapped all active appointment slot types to the new set of national appointment categories, and are complying with the August 2020 guidance on recording of appointments
- Percentage of patients who had to wait two weeks or less for a general practice appointment
- Number of referrals to the Community Pharmacist Consultation Service per 1000 registered patients
Deliver better outcomes for patients on medication (2022/23 onwards)
- Percentage of patients of patients on NSAID and anticoagulant also prescribed gastro-protective therapy
- Percentage of patients on NSAID also on gastro-protective therapy
- Percentage of patients on two anti-platelet therapies also on gastro-protective therapy
- Percentage of patients prescribed a direct oral anti-coagulant, who received a renal function test and a recording of their weight and Creatinine Clearance Rate, along with a change or confirmation of their medication dose
- Percentage of patients on the QOF Asthma Register who were regularly prescribed an inhaled corticosteroid over the previous 12 months (higher % better)
- Percentage of patients on the QOF Asthma Register who received six or more SABA inhaler prescriptions over the previous 12 months (lower % better)
Help create a more sustainable NHS
- Metered Dose Inhaler (MDI) prescriptions as a percentage of all non-salbutamol inhaler prescriptions (lower % better)
There are many aspects of the new PCN specifications and IIF which will require actions to be taken at practice level. However, it is worth discussing the required changes in practice, procedures, and audits with all PCN practices so that you can share workload and learning.
Practices signed up to the PCN DES will be auto-enrolled to these elements of the PCN DES. Practices will have to opportunity to withdraw from the PCN DES in October.