The PCN DES was published on 31^st March, and at the very end of this 104-page document (from p96 onwards!) we find detail of the Investment and impact Fund (IIF). In our latest Practice Manager Panel podcast episode, we discussed the impact of QOF on practices, so in this article I will focus on the updated IIF.

The first thing to say is the published detail of the IIF (there is also an IIF guidance document here) indicates that it covers a total national value of £50.7M, spread over six indicators. However, the funding commitment for the IIF for 2021/22 is £150M, and the remainder of this year’s funding will be allocated via additional indicators that will not be introduced before October. It is likely that any new indicators will be linked to delivery of the new PCN DES specifications expected at that time.

What this means is that the IIF is going to grow substantially in value, and therefore importance, in the coming months and years. It will triple from its current value of £40.5k (to the “average” PCN) by the end of 21/22, and be worth six times as much (nearly a quarter of a million pounds) to each PCN by 23/24. So, while £40.5k divided by the number of practices in your PCN might not feel very important right now, given all the other pressures the practice is dealing with, this could change pretty quickly.

A key lesson from the IIF in 20/21 was the importance of having a measurement system in place. Indicators such as social prescribing referrals (which feature again this year) are only recorded if they are in the GP systems, and so it is up to practices to make sure that not only are they making the appropriate referrals, but they are also recording them appropriately.

It is also worth bearing in mind that the money for the 20/21 IIF has not yet been received by PCNs. Apparently, this is due out in the next month or two (it seems the national team have equally experienced challenges in recording and reporting the IIF data!). In the PCN DES, it states that PCNs must “commit in writing to the commissioner to reinvest any IIF achievement payment into additional workforce, additional primary medical services, and/or other areas of investment in a core network practice, e.g. equipment, premises” (10.6.16). What this actually means in reality remains to be seen, as so far PCNs have not been asked to make such a pledge, and any issues with the receipt of last year’s money may impact PCNs’ enthusiasm to pursue this year’s targets. However, it would seem prudent for PCNs to ensure they have a plan in place for the money.

This year, the IIF so far contains 225 points worth £200 each. As per last year, it works like a QOF for PCNs. Of the six indicators, three with a combined value of 142 points are related to flu vaccinations (65 and overs, 18-64 year-olds in an at-risk group, and 2-3 year olds). Social prescribing referrals (20 points) and annual LD health checks (36 points) feature again, and there is one new binary target (27 points) where PCNs provide “Confirmation that, by 30 June 2021, all practices in the PCN have mapped all active appointment slot types to the new set of national appointment categories”.

The thresholds in the IIF will be challenging for many – e.g. a lower threshold of 80% for >65 flu vaccinations and an upper threshold of 86%. Many PCNs struggled to achieve last year’s required number of social prescribing referrals, and the target is even more onerous this year. These challenging goals mean that the way in which PCNs tackle variation in performance amongst member practices will become an issue that will be increasingly difficult to ignore.

At this stage, it seems that PCNs should really use the IIF as it currently stands with its limited funding as a learning tool and preparation for when there is more at stake. The key questions PCNs should address at the start of the year are:

• What is the plan for the funding earned by the IIF, and how does it fit within the overall PCN vision and plan?
• Are appropriate recording mechanisms in place, and how will performance be monitored during the year by the PCN?
• What is the plan for achieving the targets – is there simply an expectation that each practice will deliver their share (and what happens if they do not?), or is there a more joined-up, PCN-wide plan to ensure delivery?