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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

  1. Improving prevention and tackling health inequalities in the delivery of primary care
  2. Supporting better patient outcomes in the community through proactive primary care
  3. Supporting improved patient access to primary care services
  4. Delivering better outcomes for patients on medication
  5. Helping create a more sustainable NHS

To support these priorities NHSEI will invest £43m across England to fund PCN leadership and management development.

Extended access

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

Service

Expected from October 21

Expected from during 2022/23

Cardiovascular disease

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

Anticipatory care

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

Personalised Care

Deferred to 2022/23

From April 2022 there will be three areas of focus for personalised care:

  1. expansion of social prescribing
  2. supporting digitised care and support planning for care home residents;
  3. shared decision-making training.

 

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

 

Personalised Care

  • 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)

 

Final thoughts

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.

 

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