One of the big initiatives in the new contract is the Primary Care Network (PCN) DES. PCNs must be geographically contiguous and comprise practices with total list sizes of 30-50,000 patients. The DES will provide funding for additional resources at a network level, who will then be expected to work within the member practices. Initial funding will be for one clinical pharmacist and one social prescriber per network, and later funding streams are expected to support other types of resources such as physiotherapists, physician associates and more. The workforce and network will be led by a Clinical Director, chosen from within the GPs of each network.

What do practices need to do?

To become a network, practices will need to apply to the CCG by 15th May 2019. The application should include: names and list sizes of member practices; a map of the network area; the name of the clinical director; the name of the single provider who will receive the funds; and a signed Network Agreement.

The first and most urgent step is to identify and agree the network area. For some PCNs the area will be obvious and practices will already be working closely together. In other places agreeing an area will be more challenging, but it is clear that any practices which do not join a PCN will not benefit from any of the associated new funding, and indeed risk losing existing funding since the extended hours DES will also move to the PCN. Further guidance should be available shortly from NHS England, including a template Network Agreement.

Legal Entities

It seems likely that PCNs will become an important part of the primary care landscape, but with so little known about how they will develop, practices would be well advised to keep their structures as flexible as possible at this stage. As such, whilst it may make sense for some PCNs to establish a separate provider entity at some point, practices should probably look to use existing provider entities for now. There may however be particular reasons why this will not work for some PCNs, so if you are in any doubt you should take advice.

Legal Concerns

PCNs give rise to a number of particular concerns which will need to be considered by practices:

1. Employment. The DES anticipates the employment of new resources who will work across the network. It is likely that whichever practice receives the funding will also employ the new resources, but consideration should be given in their employment contracts to the basis under which they will work in the other PCN member practices. There are a number of options, but it is important to think these through and document them properly to avoid tax and legal problems later.
2. Governance. Over time, significant amounts of money will be flowing to the PCN. How will decisions be made between the PCN members, how will disputes be resolved, and how will liabilities be shared? Key questions such as these are unlikely to be in the template Network Agreement and will need to be documented separately.
3. Pensions and Tax. Will income from the DES be pensionable, and how will it be taxed? The answer to this question will depend on both the legal entities involved in the PCN, and the contractual nature of the relationships. To avoid future problems PCNs would be well advised to discuss this at an early stage with professional advisers and properly document the various relationships.

Conclusion

PCNs are a significant new part of the primary care landscape and practices should be preparing now. They should familiarise themselves with the information on the DES available from NHS England and the BMA, organise into geographically coherent areas, and ensure that they register in time.

In parallel they should take specialist advice on the best way to organise the funding flows and the contractual relationships to minimise the risk of future tax, pension and legal problems arising.

If you have any questions about PCNs, please contact Nils Christiansen at n.christiansen@drsolicitors.com or call 01483 511555