Capsticks Solicitors‘ Partner Peter Edwards and Legal Director Neha Shah, have prepared a short blog for Practice Index addressing some of the questions they are receiving from GPs and practice managers on Primary Care Networks and staffing issues.

By 15 May 2019, Practices will need to provide the CCG with the following information:

• the names and the ODS codes of the member practices;
• the network list size (as of 1 January 2019);
• a map clearly marking the agreed network area;
• a copy of the initial Network Agreement;
• a named clinical director;
• the provider that will receive funding on behalf of the Network.

However far you’ve progressed with the detail of PCN discussions, staffing considerations are important.

What’s the incentive?

One of the incentives for participating in a Primary Care Network is that practices will be able to benefit from the Additional Roles Reimbursement Scheme which was announced in the 2019 GP Contract Framework. Under this scheme, additional funding will be made available to PCNs to reimburse 70% of the employment costs for clinical pharmacists, physician associates, first contact physiotherapists and first contact community paramedics and 100% of the employment costs of social prescribing link workers, up to the relevant maximum amounts.

Sounds good – what’s the catch? 

Because the scheme is seeking to grow additional capacity through new roles, reimbursement will only be available for “demonstrably additional people”. The Contract Framework makes it clear that NHS England will expect CCGs to continue any local schemes which fund posts in the five reimbursable roles. What is less clear is how readily PCNs will be able to modify existing roles in order to enable current staff to take up posts within the funded categories.

The only exception to the ‘additionality’ rule is existing clinical pharmacists reimbursed under either

(i)  the national Clinical Pharmacists in General Practice scheme, or

(ii) the national Pharmacists in Care Homes scheme.

Both of these schemes will be subsumed into the new funding arrangements.

But what happens when the funding ends?

The national funding for the Additional Role Reimbursement Scheme will run until 2024. From that point, it is unclear whether the funding will continue or whether PCNs will bear the full cost of the additional staff themselves. This means that in setting up employment arrangements, consideration should be given to whether the appointments can be made on a fixed term basis linked to the available funding, and how any redundancy costs that arise when the funding ceases will be apportioned between members of the PCN.

What are the employment arrangement options for my PCN?

The framework makes it clear that each PCN can determine the employment arrangements for additional staff funded under the scheme. Options include employment by a “host” practice; an existing Federation or on a joint employment basis. Different documentation will be needed depending on the option chosen by the PCN, but some common issues that will need to be addressed are:

• How will the additional staff be managed on a day to day basis?
• How will employment liabilities be shared between PCN member practices?
• Will the chosen option enable the additional staff to join the NHS Pension Scheme?
• Is there a risk that the employment arrangements will lead to a taxable supply of services for VAT purposes?

How do I choose the best model for me and my network? 

There are several different network models available to PCNs which will affect issues such as practice relations, funding, operational management and staffing. You will need to understand the administrative, legal and financial implications each model has before you can make an informed decision on how to proceed. To make an informed decision on the best approach for your practice there are various resources you can research including the BMA Primary Care Network Handbook and the Practice Index Ultimate PCN start up kit

The key schedules in your Network Agreement must reflect the requirements of your Network as these schedules include the details of your governance arrangements; funding; service delivery model and workforce arrangements, and so it is essential that this works best for you and your network.

If you would like to find out more about legal support then contact Capsticks