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Primary Care Networks: strategic finance and data-based hiring

Recognising who you need, when and where they are needed is paramount to making the right decisions in business. Primary Care Networks (under the DES network contract) are being given the option to recruit pharmacists and social prescribing link workers (2019-20), physician associates and first contact physiotherapists (2020-2021) with community paramedics coming on board in 2021-22. The aim of the scheme (in theory at least) is to build additional capacity through the new roles and help to solve the workforce shortage in general practice.

Not all that shines is gold however…

The funding will only cover new staff rather than existing roles or vacancies, but networks will still have the flexibility to decide how many of each of the types of staff they want to employ.

And before you fall head over heels with the thought of increasing your workforce, caution is advised – the rules are that reimbursement can only be claimed for 70% of four of the roles mentioned above (pharmacist, physiotherapist, physician associate and community paramedic). Regarding the social prescribing link workers, the cost is covered 100% and these percentages include salary, ER NI, and pension contributions.

Given that the contract only took effect from the 1st July, for the financial year of 2019-20 the maximum amounts for each role are restricted to nine months of the annual reimbursement amounts and from April 2020 onwards, each network will be allocated a maximum reimbursement sum which will be based on its weighted patient population share. That means that the bigger the network, the smaller the share for each practice. Reimbursement can be claimed up to the maximum amounts set out for each of the five clinical roles, and within a network’s maximum reimbursement sum.

For this inaugural year (2019-20), the maximum amount that can be claimed by PCN’s with less than 100k patients is £53,942. The maximum amounts PCN’S can claim for roles in 2020-21 are as below:

  • Clinical pharmacists and physiotherapists, band 7-8a: £38,969.
  • Social prescribing link workers, up to band 5: £35,389
  • Physician associates, band 7: £37,607
  • Community paramedics (from 2021-22 only): £31,479

Whatever PCN’s spend this year beyond the amounts above will have to be paid for by the PCN’s. Figures from 2021-22 onwards include an indicative uplift which will depend on national pay negotiations and are therefore subject to change. By now, you should have some questions in your head based on what you read above such as:

  • Some PCN’s have run into problems with hiring social prescribing link workers due to issues with VAT – this has been a concern for some PCN’s.
  • Although NHS England guarantees to cover 70% for four of the additional roles and 100% of the fifth, there is no reference nor assurance of funding beyond 2021-2022 and some PCN clinical directors claim that the funding provided is only enough to cover the cost of less experienced and/or less qualified staff such as pharmacy technicians or paramedic technicians (as opposed to an experienced clinical pharmacist or a paramedic practitioner for example). This is corroborated by a report by the Pharmacists Defence Association (PDA), which states that 71% of 500 pharmacists working in general practice in England were paid a salary equivalent to band 8a or above (defined as £43,042 – £49,969 for salaried with an additional £24 to £28/hour for self-employed). Clearly by now you realise there is a discrepancy between funding allocated and what is required?
  • As a throwaway fact, still on the same report more than a quarter of pharmacists (27%) said they were at bands 8b, 8c or above – equivalent to £49,970 or above.
  • None of the available funding can be carried forward into the next financial year. However, from 1st April 2020, PCN’s can make use of additional funding that becomes available – maximum of £38,969 for a first contact physiotherapist and £37,607 for a physician associate.
  • What happens beyond 2022 – where will the money come from to fund these additional roles and will PCN’s be able to meet their obligations with the staff they hired?
  • How will the cost of the staff hired be divided between the practices within the PCN? And how to ensure fairness when the staff has been assigned to work at a practice on a specific day of the week (a Monday, for example) but fails to do so on 2 or 3 days of the year because of bank holidays – how will that PCN ensure that no practice overpays for a service which is not getting in its entirety?

So how can you make the best decision? What tools can you use?

Data is crucial in any decision (good or bad) and regardless if your practice uses System One or Emis Web, there are a lot of searches you can create (some may already be available as clinical utilities in your clinical system). Examples of data you can search for include (but are not limited to):

  • Create / run searches to identify why patients come to your practice – what health issues are the most common, which specialities does your practice refers the most to, how many home visits requests do you receive in your practice over a certain period.
  • Who are the most expensive staff in your payroll and are you using them to the full extent of their ability i.e. are you getting the most “bang for your buck”?
  • How many of your patients (calculate this as a percentage) need to see a GP and how many of their health issues / queries could be resolved by someone else other than a GP (in theory your most expensive resource within general practice)?
  • Are there any other resources available to you (outside your practice but within the wider health community such as community services which you can refer directly into) which you are not making enough and appropriate use of?
  • Payroll data: pension contribution which is 14.38% for 2019-20 will be paid in full by PCN’s; This will rise to 20.69% for 2020-21 and you should cost this increase into your budget for the next financial year when hiring someone. Note that this year, the NHS paid the difference between the two pension rates directly to the pensions agency on behalf of the practices but that will not be carried forward!

Data and technology are extremely useful when it comes to saving costs and increasing efficiencies in business processes! Tree View Designs developed a new technology called Group Central Management (GCM) which enables practices working at scale (within a PCN or a Federation) to manage their website content centrally and dispatch new pages, alerts, upcoming events, maps and more to multiple websites at the touch of a button and in real time. Two of it’s most amazing features include Soft Push and Hard Push:

  1. Soft Push – Allows a GCM admin to dispatch content which all receiving practice need to review before publishing on their website
  1. Hard Push – Allows a GCM admin to dispatch content and is automatically displayed on all connected sites without any user intervention
  2. Nominated users at each practice receive a GCM email notification to inform them of the new content that’s either available for them to publish or which has already been published by the GCM Admin to their website