Primary Care Networks (PCNs) are new collective providers of primary care and other community based healthcare. PCNs are organised around a local community of 30 to 50,000 people, and comprise the GP practices serving those patients and other related healthcare providers.
PCNs are currently in the set up phase, and in our experience there is considerable confusion about the practicalities of how PCNs are supposed to work. PCNs are essentially contractual arrangements between healthcare providers, but they create significant issues around important matters like NHS Pensions, VAT, employment liabilities, governance, risk sharing and financial control.
In order to release all the funding, each PCN must have a signed PCN agreement based on the national template but tailored to their circumstances by 30 June 2019. In addition, all PCN member practices must ensure they have in place a data sharing agreement and, if appropriate, data processor agreements (both using the national template which should be published soon). Each PCN must confirm to the CCG that these documents are in place before the PCN will be considered established, so if the 30 June deadline is missed the PCN will not be able to start providing services and any payments due may be rebated.
What is in the PCN Agreement?
The PCN Agreement is a legally binding document. As such it is important that practices understand the rights and obligations which they are signing up to. It incorporates four elements:
Mandatory fixed clauses. These cannot be changed other than by direction from NHS England.
Mandatory extendable clauses. These clauses must apply, but can be supplemented with additional wording. Examples of this include the clauses relating to information sharing and confidentiality, and processes for joining and leaving the network.
Replaceable clauses. These are suggested default clauses, but can be modified or replaced entirely at the discretion of the PCN. Examples of this include the clauses on variation and dispute resolution.
Locally defined clauses. PCNs can add their own clauses to the Agreement, so long as these do not conflict with other parts of the document. Examples of additional clauses which PCNs might wish to consider include indemnities and limitations of liability, since the basic template agreement does not limit liability and many practices will be hesitant to sign without this.
Do PCNs need help to complete the Agreement?
PCN member practices could in theory simply sign the template PCN Agreement in un-amended form plus the data sharing agreement once this becomes available. Given the risks and complexity involved, this is not generally probably advisable unless you are a practice large enough to be your own PCN. Key information such as decision making and how revenue and costs are to be shared is missing, and the template Agreement cannot easily be varied once signed. The default position is that all changes must be agreed unanimously, so a single member could prevent all the others from making the changes they felt were needed once the PCN was operational.
The PCN Agreement is a legally binding document which will govern an increasing share of the services to be provided by General Practice. Given that the future development and direction of PCNs is still unclear, it would, as a minimum, be advisable to increase the flexibility of the variation provisions, specify the financial arrangements and extend or modify a number of the legal provisions in the template. It is hard to see how this can be done without involving specialist accountants and solicitors who understand the tax, pension and legal implications both on the PCN and on the underlying practices.
Next Steps and Costs
Time is short and the area is complex, but it can be successfully navigated with expert help. At DR Solicitors we have developed various operating models and have carefully considered alongside other professionals how to minimise the risks, provide flexibility for future change, and embed appropriate governance. We strongly recommend that PCNs now engage ourselves, alongside specialist medical accountants, to assist with developing their PCN Agreements and to ensure that they are in the best position possible for the 30 June deadline.
We are able to offer a Fixed Fee to draft your PCN Agreement, and also provide discounts where PCNs instruct us jointly through, for example, an LMC, a CCG, a federation or a super-partnership.
We are a unique law firm in that we bring Legal, Chartered Accountancy and Management Consultancy skills all together under one roof, so we able to provide a practical and holistic approach to designing PCNs.