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Supported by and delivering for:
London’s NHS organisations include all of London’s CCGs, NHS England and Health Education England
Transforming Primary Care
Primary Care Networks (PCN)
Development Support
30 July 2019
Cover Sheet
Action Required
Decision
Required
Debate Assurance
Discussion
Essential
Discussion
desirable
For
information
Title Primary Care Networks (PCN) Development Support
Author(s)
Sultana Rahman, Assistant Director for Primary Care
Transformation and Maria Rodrigues, Senior Programme
Manager, PCN and Access Lead
Lead Liz Wise, Director of Primary Care and Public Health
Commissioning and Transformation
Clinical
Lead
Jonty Heaversedge, Regional Medical Director for Primary
Care and Digital Transformation
The purpose of this report is to:
The Delivery Oversight Group is asked to discuss and consider:
• What local discussions have taken place to date and what approach are STPs considering to
help implement the PCN development support programme ?
• The model of PMO support to be put in place? Options include regional PMO or a mixture of
STP/regional led PMO: would need to agree level of contribution.
• What are the potential areas of work and events that could be done on a once for London
basis – e.g. a London CD event, cross STP leadership programmes.
• What are the approaches to procurement – is there value in cross London working to support
delivery and minimise variation. As a minimum a market engagement event could be held.
• New regional PCN delivery support group - who will be the STP leads – they will also be the
main point of contact for PCNs.
• Agree next steps.
• Provide an overview of the national PCN development support offer
• Propose and explore a London approach to delivering the PCN development support
programme
• Agree next steps for delivery
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01
Transforming London’s health and care together
PCN Development Support
context
3
PCN Development Support offer - Context
• NHS England and NHS Improvement are developing a PCN development support
prospectus which will consist of eight domains which will be focused on/funded:
1. Organisation Development and change
2. Leadership development support
3. Supportive collaborative working (MDTs)
4. Population health management
5. PCN set up support
6. Social Prescribing and asset based community development
7. Clinical Director development support
8. Identifying, evaluating and sharing learning
• PCNs will need to do a self assessment to help understand where they are and to
feed into plans.
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PCN development support offer
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STP Funding Points to note:
NCL £1.2m • Funding was allocated/transferred to STPs in June 2019
and includes Clinical Director support
• Funding is recurrent for 5 years therefore focus likely to
flex
• National launch of a PCN Development Prospectus
expected by end of July 2019
• The national prospectus is expected to describe what
good looks likes across eight areas to help local delivery
• Regional assurance process needs to be in place by 31
July 2019
• PCN plans should be based on self assessment
NEL £1.6m
NWL £1.7m
SEL £1.4m
SWL
£1.1m
Total £7m
Additional support:
Support also available from the Time for Care Programme (national programme)
which includes an average of 1-day co-ordination per STP/ICS and 1.5 days
development support to PCNs
PCN development funding – some must do’s and
don’ts ( Nb based on latest national guidance)
Can do’s
Freeing up clinical time
Local transformation resource support
from ‘NHS family’ bodies e.g. the
leadership academy, CSUs, NHSE
sustainable improvement team,
federations, at scale primary care
providers, NHS Trusts
Commissioning support from
providers via the HSSF or through
other procurement mechanisms
Can’t do
Anything that is already covered in the
contract, including Clinical Director
time
Anything that is already funded by the
CCG or another system partner
Non-transformation costs
Work that isn’t related to PCNs
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Clinical Director development and support
• Developing relationships and working closely with other PCN Clinical Directors, LMCs, local commissioners and clinical leaders of other Health and Social care providers
• Working collaboratively with other PCN Clinical Directors, playing a critical role in helping to ensure full engagement of primary care in developing and implementing local system plans
• Providing strategic and clinical leadership to the PCN, developing and implementing strategic plans, leading and supporting quality improvement and performance across member practices
• Providing strategic leadership for workforce development through assessment of the clinical skill mix and development of a PCN workforce strategy
• Supporting PCN implementation of agreed service changes and pathways, and working with member practices and the commissioner and other networks to develop, support and deliver local improvement programmes aligned to national priorities
• Developing local initiatives that enable delivery of the PCNs agenda by working with commissioners and other networks to meet local needs and ensure comprehensive coordination
• Facilitating member practices to take part in research studies and acting as a link between the PCN and local primary care research networks and research institutions
• Representing the PCN at CCG, ICS and STP level clinical meetings – contributing to strategy development and the wider work of the ICS
• CD development will be a major part of the PCN development plans
• Funding provided for 0.2 FTE ( Under Network DES)
• Reports from local system suggest varying levels of experience of CDs and a requirement to provide immediate support
• CD’s are being approached by a range of providers and system leaders
• CD role includes the following responsibilities:
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By March 2020, PCNs should:
• Have an idea of where they are aiming to get to, know where they are on the journey to get there, and are making progress
• Are functioning effectively as teams and have made use of additional roles
• Have worked on/are working on a service improvement project of some kind
• Have formed links with other local partners, such as community service providers and other NHS organisations, local authorities and the voluntary sector, and are playing a role at the place and system level
• Have used a diagnostic process to establish development needs eg maturity matrix,
• Have a development plan in place, and have started implementing that plan;
• Have worked with community trusts and other relevant partners to ensure staff working in the community are aligned within an MDT for that footprint;
• Are ready to deliver service specifications
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02
Transforming London’s health and care together
Timeline for delivery
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Key milestones for mobilising PCN development support, 2019-20
Jun Jul Aug Sep Oct Oct – Mar
Funding Released to ICS/STP
Funding parameters agreed. PCN development prospectus finalised
ICS/STPs support PCNs in self- assessment, identifying areas of initial focus, and determining support needs
ICSs and STPs collate support needs and put together system plan for PCN development
Development support mobilised
Systems and CCGs support PCNs to review progress against PCN priorities. Areas for additional support identified. Learning and best practice shared.
Source: NHSE/I 10
PCN delivery timescale
What needs to be done? By when? By whom?
Agree governance arrangements and timescales July 2019 Delivery Oversight Group
Explore once for London offer opportunities ( pre
self assemnt) and mobilise
July 2019 STPs and Regional team
Explore once for London support (PMO, STP lead
areas, regional team)
July 2019 STPs and Regional team
PCN self-assessments July – August 2019 PCNs with STP/CCG and other support
Identify further once for London opportunities
following PCN self- assessments
August –September 2019
ICS/STPs
Develop STP level PCN development support
plans (There may be CCG/PCN level plans in place
to underpin the STP )
September 2019 ICS/STPs
STP local engagement and sign off plans September 2019 STPs/CCGs - use of London template to
be considered
High level review, feedback & assure STP plans September 2019 Regional team & Delivery Oversight Group
London events – CD event, PCN event/market
engagement ( details to be agreed)
September 2019 Regional team
Development support mobilised/deployed October ( may be earlier in some
cases)
STP and regional team ( if once for
London)
Review progress against plans January 2020 ICS/STPs
Regional team
End of year evaluation – outputs/impacts March - April 2020 ICS/STPs
Regional team
The above is a proposed outline timetable – will
need further discussion and consideration 11
03
Transforming London’s health and care together
London approach and
arrangements for PCN
development support
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PCN Development Partnership
NATIONAL
• Support co-creation of the PCN Development Prospectus
• Develop PCN Maturity matrix
• Mobilise PCN Development Set- up support
• Support Clinical Directors
• Engage with the market, NHS internal/external stakeholders
• Capturing learning & sharing best practice
REGIONAL
• Understand system plans for PCN development, and agree specifications for how funding is deployed
• Understand how development support is progressing
• Be able to review a summary of the outputs of development support, and impact on PCN progress
• Support system primary care leads to develop effective system PCN development plans, sharing learning & approaches between
system
SYSTEM
• Have a lead (named director level) for PCN development, and proactively make PCN CDs aware of appropriate contact points
• Engage with PCNs to support them to identify level of development and support needs, forming an aggregate view across the system
• Identify and deploy funding and associated support to meet PCNs’ collective development needs, making use of system, wider NHS and external expertise and holding suppliers to account for delivery
• Understand PCN progress and impact of support, and gather learning for subsequent years
Source: NHSE/I national 13
Potential London approach ( Discussed at LRET and supported)
Regional Oversight and Coordination
• Oversight and support through a PCN
Development group reporting into the
Primary Care Delivery Oversight
Group
• STP contribution from PCN
Development funds towards light touch
PMO
• Once for London commissioning of
development programmes common to
all PCNs for example:
– CD leadership development
– Governance
– PCN start up
Support through Regional
Transforming Primary Care
Programme Support (HLP)
• Market engagement with development
providers
• London PCN/CD events and fora
• Specialist support
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PCN Development fund - Key principles and funding parameters
• Must be locally led, STP/ICS lead on providing support to PCNs
• To be ICS/STP led – providing support to PCNS and working with CCGs and regions.
• Expectations is that each STP/ICS will develop one plan based on their local engagement work with CCGs/PCNs – Implementation and assurance across the STP to be agreed locally
• STPs/CCGs would have to follow appropriate local and national procurement processes
• Consider using local systems to support this work where appropriate – e.g. NHS family bodies and use of training hubs
• Intention to make it a light touch process which supports ‘bottom up’ ‘locally led’ process
• Principles would be in line with national criteria i.e. what it could be used for (8 domains) and to follow any requirements on assessing need e.g. using a self assessment framework
• Priorities should be based on local need and linked to prospectus domains - however should consider areas such as wider partnership working
• Each area to set aside funding for PCN development support and CD development
• Money should reach the front line
• Money should align to other funding sources and not duplicate other sources of funding
• Money should be spent in year
• Plans should be clear on outcomes and outputs
• Should be a director lead in each STP ( with resources) who is responsible for roll out of programme- work with PCNs, provide support, identify resources, develop specs, procurement, accountability, etc.
• This process would need to feed into assurance that national are currently proposing and share outputs
• Will be STP oversight but regional operational oversight and support provided by London PCN Group and transforming primary care regional team
• Formal regional governance, reporting and oversight will sit with the London Delivery Oversight Group
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