The hub has been developed in a way that reflects the need to uphold clinical safety, deliver financial sustainability and ensure robust governance processes are in place to protect the patient. The PCN has developed several templates and framework documents that other PCNs can adapt and use as part of a “lift-and-shift” approach.

Data protection 

The project team worked with an independent data protection officer to ensure the model is safe and compliant. This involved completing a comprehensive Data Protection Impact Assessment (DPIA) that addressed each element of the proposed operating model and identified necessary supporting documentation for the project. You can download the data protection impact assessment here.

Clinical safety 

Standard clinical safety case resources have been developed for delivering federated PCN-level online consultations, and the team has worked closely to identify potential hazards and provide suitable mitigations in line with the clinical risk management standard set out in the Health and Social Care Act 2012. The scope and requirements of the PCN’s clinical safety team are aligned to national guidance and best practice. The programme has also been fully integrated into the PCN’s standard clinical governance structures and processes. A range of clinical safety resources are available to download.

Funding

An important principle when developing the hub operating model was to ensure that it was financially sustainable. The initial staff and IT system costs involved were drawn from three main sources:

1. The Enhanced Access contract
2. Investment and Impact (IIF) funding
3. Seasonal Capacity and Access funding

The PCN’s Enhanced Access contract generated approximately £390,000. Around £210,000 of this funded the Advanced Nurse Practitioners, while the administrative support for those clinicians were claimed under the ARRS. This enabled the online consultation eHub and Minor Illness hub to be provided during core and enhanced access hours. The remaining Enhanced Access funds were distributed to practices to support the remaining contracted hours.

Additional PCN hub services and resource were largely made up of a mixture of ARRS and PCN-funded roles (see figure 8 below). For IT investment, the PCN spent around £25,000 on the various clinical systems and configuration costs. This was drawn from the previous year’s IIF performance and profits from earlier contracts. Although Kent and Medway ICB had already procured eConsult, Edenbridge Apex and Ardens on behalf of its PCNs, it was important that the PCN budgeted for the annual recurring licence costs and any additional support for the systems procured directly.

Other available funding streams

Since the project began, both Advanced Nurse Practitioners (under the category of Advanced Clinical Practitioners) and the Digital Transformation Lead have been recognised under the ARRS scheme, which creates further financial relief. This year, PCNs are also able to access new Capacity and Access Support payments. Please check NHS England’s Ready Reckoner to calculate all potential funding streams available to finance a hub model.

“By doing a lot of the thinking upfront, we’ve built solid foundations in terms of embedding compliance and safety processes into our operating model. This has helped us evolve quickly while assuring ourselves that the services we provide are safe and resilient.”

Kim Lee, Folkestone, Hythe and Rural Operational Lead

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