Is this the end of Primary Care Networks (PCNs)?

In most areas, the PCN footprint is the neighbourhood. We see the SNP Contract as an evolution and a strengthening of the PCNs which have been running since 2019. To that end, we will be protecting the PCN funding (including the Additional Roles Reimbursement Scheme) as systems move towards SNP Contracts.

What is the future of the Network Contract DES (PCN DES)?

We want, in the short term, to give commissioners the choice over keeping the current PCN DES or moving to one of the proposed options in the consultation document. Practices would have the option to remain in the PCN DES or take up one of the other options if their commissioner proposes it. We see Local Medical Committees (LMCs) playing a key part in coordinating this transition with commissioners and practices.

Will general practice income be reduced if locally commissioned services are bundled into an Single Neighbourhood Provider (SNP) Contract or modified PCN DES?

We see an opportunity for general practice to grow as neighbourhoods deliver more services. We would protect the income by putting minimum funding requirements in place for any variations to the PCN DES and in the SNP Contract. We also think that for general practice to opt out of the PCN DES and switch to an SNP Contract, they will want to see not only simpler service specifications but additional services and funding.

Which organisations could hold the Multi-Neighbourhood Provider (MNP) Contract?

The NHS Standard Contract can only be held by a single provider, and this will not change. Where an MNP is a collaboration of multiple organisations, a host or lead provider would hold the contract and the relationships between partners would be governed through a collaboration agreement.

Will trusts be the only organisations that can take on an NHS Standard Contract?

Trusts may be more familiar with the NHS Standard Contract, but they are held by many GP organisations too. We see many organisations having the potential to take on MNP Contracts and importantly, we are considering a safeguard where commissioners would need to ensure there is GP support for any MNP.  We also want to make procurement proportionate and seek your input so we can do that through additional guidance to commissioners.

What organisations could hold a SNP Contract?

The Single Neighbourhood Provider Contract, or SNP sub-contracts (which are mandated by the commissioner and entered into between the MNP and the SNP on the basis of the “Neighbourhood Schedule”), would be awarded to all eligible providers (which meet the legibility criteria, which we expect will include having access to the registered patient list) who express an interest.

Will PCNs need to incorporate or change organisational form to be awarded an SNP Contract?

The SNP would need to be held by a legal entity. PCNs would need to consider how they would meet this requirement to hold the contract. 

Does the MNP award the SNP Contract?

The MNP would be told by the commissioner when it must enter into a sub-contract with an SNP for single neighbourhood-level services. The MNP would manage the whole MNP Contract (including in relation to the delivery of the neighbourhood-level services by the SNP).

What is the difference between Schedule 2L of the NHS Standard Contract and the new Schedule being proposed under the new Neighbourhood Directions? 

The new Neighbourhood Directions would be more flexible than the current Schedule 2L and would be designed specifically for Single Neighbourhood Providers and the services that they deliver.   

What is the difference between a SNP Contract and a sub-contract from an MNP?

It is intentional that there would be very little or no difference between the SNP Contract and the neighbourhood-level SNP Sub-contract from an MNP. The SNP Contract would be created based on new “Neighbourhood Directions”.  These Directions would also underpin the new “Neighbourhood Schedule” within the MNP Contract, ensuring consistency and certainty in the delivery of these services, whether they are under the SNP Contract or a sub-contract from an MNP. It is intended that access is available to the NHS pension scheme and to state backed indemnity. Where PCNs are mature and stable we expect that they will be able to develop into SNPs without complexity.

Could an MNP sub-contract the delivery of enhanced primary medical services in a single neighbourhood to a PCN?

The MNP would be mandated to sub-contract the neighbourhood-level primary medical services using the “Neighbourhood Schedule” arrangements to SNPs. Where practices choose not to “opt into” an SNP service, the MNP would be required to deliver the services to patients. Practices would have the ability to exit and join SNPs at defined times, and the MNP would enable this. 

Where an MNP has a PCN within its geography (rather than a SNP), the MNP would be able to sub-contract the delivery of enhanced primary medical services to PCNs.

How will MNPs be procured?

The procurement route for MNPs may vary depending on whether the MNP is (a) co-ordinating the delivery of neighbourhood services or (b) co-ordinating and delivering healthcare services. To fall within scope of the Provider Selection Regime (PSR), the main subject matter of the contract needs to be the provision of healthcare services.

Could an SNP provide primary medical services (under a GMS/PMS/APMS contract)?

Yes, where a GMS/PMS/APMS practice complies with its contract and the relevant Regulations in relation to the sub-contracting of primary medical services, it could sub-contract to the SNP to deliver primary medical services to patients.