Understanding Primary Care Networks: Structures and Contracts

1. Primary Care Networks: Structures and ContractsWhat you need to know Shanee Baker LMC Law Limited

2. 1. What is a PCN? • A group of practices collaborating together under the PCN Network Agreement DES • A PCN is not a separate legal entity: partners still have joint and several liability • A DES is an addition to a practice’s core contract - that is why the process by-passes procurement

3. 2. Structure Flat Practice or Lead Practice • Basic model - several practices working together • One practice chosen as the "Nominated” or “Lead" practice • Shared workforce, with the Lead Practice being the employer and holding funds What do you need for this structure? • Separate bank account or ring-fenced funding • Appropriate clauses in the Network Agreement • Amendments to your existing Partnership Agreement • Decide on the added responsibilities of the Lead Practice • Note. Risk can be SHARED amongst members

4. 3. Network Contract Terms • The mandatory clauses cannot be varied • these will always be subject to a national variation agreed between NHS England and the BMA • Non-mandatory clauses can be agreed and discussed between PCN members • Members may join and/or leave a PCN • there is a minimum process to be followed which is compulsory, but commissioner approval is not required • Information sharing and confidentiality • National data sharing agreement will be issued • PCN permitted to have arrangements with organisations outside of the PCN - this is a matter for the PCN to determine

5. 3. Network Contract Terms cont. • Certain clauses are mandatory, but you may agree specific issues in relation to: • GOVERNANCE • PROCESSES • DECISION MAKING • ELECTION OF CLINICAL DIRECTOR • WORKFORCE ARRANGEMENTS • HOW THE PCN MEMBERS WILL WORK COLLABORATIVELY • PCN FINANCIAL ARRANGEMENTS • DEVELOPING ARRANGEMENTS FOR MANAGING CONFLICTS OF INTEREST • ANY ADDITIONAL ARRANGEMENTS FOR ADDING A NEW MEMBER OR REMOVING AN EXISTING MEMBER • DISPUTE RESOLUTION PROCESS • Role profile/responsibilities of Clinical Director must be appendedto network agreement

6. 4. Engagement of Workforce • VAT and legal implications • E.g. Clinical Pharmacists – 70% funding from commissioner Social Prescribers – 100% funding from commissioner • Need a lead practice who will be the employer • Any agreement for staff sharing must cover sessions of work within each practice, payment, liability, indemnity, absence (sickness, maternity, holiday leave, etc.) • Employment contract must allow working for other parties • Also consider:- Employment indemnity insurance Grievance/disciplinary/employment claims Pay rises/redundancy/shortfall in funding

7. 5. Creating a Separate Company Limited • Does this actually help? • Company Limited will be treated as a separate organisation from the PCN and, therefore, not part of the PCN • The individuals running the Company Limited will be the same individuals as within the PCN • Therefore, consider what the advantages of doing this are, other than creating an independent vehicle to hold funding • Company Limited could be used to provide additional services to support admin etc. to the PCN, but be aware of any VAT implications

8. NETWORK AGREEMENT: SCHEDULES 2-7

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