Most of my NHS clients understand they must work out their priorities well in advance in order to attract the most income from the Primary Care Network Direct Enhanced Service (DES) and the Investment and Impact Fund (IIF), which is what I help them to do.
In essence, the more indicators – clinical objectives – they hit, the more money they get from the IIF pot available to them. But, as with most things in the NHS, workload remains the problem. How can you prioritise these indicators when you’ve got so much else going on?
Some PCNs are much better at accessing the money than others and I have a great example from my work to illustrate how it can be done. It may appear late in the year to be discussing this, but for me it’s never too late and we are now all starting to think about IIF for 2023/24, meaning this might help you plan better for next year.
The funds are on offer – but how do we get the work done?
There was a significant increase in the contractual requirements for the Primary Care Network DES and the IIF for this financial year. This told me my clients would have to prioritise work and think in a different way about how to get things done.
Some of this required working collaboratively with our system partners, particularly around tackling health inequalities. And it also meant we had to give some consideration into how best to deploy our Additional Roles Reimbursement Scheme (ARRS) staff to meet the contractual requirements.
There’s a lot of money on offer. This was worth £150million in 2021/22 and £225million in 2022/23. But it comes with stringent contractual requirements to ensure delivery of clinical changes and objectives.
Most of my customers are very accepting that most of these indicators make sense. The general view is that for most indicators it’s good clinical practice and they don’t have objections. But again, it comes back to workload. And that’s where I spend my time, helping people align their strategy across the five areas of focus in the Investment and Impact Fund:
1. Improving prevention and tackling health inequalities
2. Better patient outcomes in the community through proactive primary care
3. Improved patient access to primary care services
4. Better outcomes for patients on medication
5. Create a more sustainable NHS
No point aiming for the full points total of all indicators – it’s better to zoom in
The number of indicators went up between 2021/22 and 2022/23.
Now the first thing I always do with the networks I work with is work out which indicators to tackle.
This year, there were initially 1,053 points available in total (it then changed with some dropped but let’s stick with it for this example). The first step is always to check the details of each indicator and run a gap analysis to show where they are currently performing in relation to the indicator targets. There’s an upper threshold and a lower threshold. The key thing is to get the full value of a point. A point is valued at £225 if you’re a 50,000-patient network.
If you’re smaller – I’m supporting a 32,000 network for example – you get £195 a point and I’ve got a 120,000 network where they’re getting just over £400 a point. So it scales up and down, depending on the size of the network but £225 a point is about average.
Therefore, if you were to get all 1,053 points, in a 50,000 PCN, at the top level of the indicator, you’re generating £236,925. That’s a lot of money on offer.
But, in my opinion, 1,053 points is not a great target to aim for. With the IIF you can pick and choose the indicators to pursue. So whittle it down and laser focus in on the ones you know you can achieve. The key then is achieving the upper threshold to attract the full value.
A PCN that understands its priorities
My good example here is North West Leicestershire Primary Care Network, who I’ve worked with virtually since inception. I run quarterly workshops with them, and the gap analysis mentioned above was done way back in February/March when we first got the documentation.
But they’ve taken extra steps. As they’ve started to engage the practices and have dialogue with them, they’ve started to have further prioritisation sessions where they have identified their absolute top areas of focus.
They’ve worked out what those priorities are, how they’re going to achieve them and who is responsible for that – an individual, the practices, the network, the GP federation that supports them or the system partners. They’re absolutely clear on responsibilities and outcomes. They then establish how they are going to measure and evaluate progress every month to make sure they stay on track to achieve the upper level of indicator.
They work their way through the top tier priorities but have also got one eye on the secondary indicators – the ones that are not the top priority, but absolutely still a priority. They want to work on those to achieve the points at the upper threshold and attract the income that goes with them.
They’ve then got a third category, which we call watch and wait. If they get through all the top priorities and all the secondary ones, then they’ll pick some of these out and get to work on them in order to bring some additional income in.
There’s also a discounted range of indicators. If all 1,307 Primary Care Networks went about this in the same way, the discounted indicators would be different from network to network because they depend on where they are and how they’re performing against each indicator – that’s what determines which ones they are going to discount.
Without accountability, targets are missed
In a previous blog and another previous blog I’ve talked about having to think in a different way to achieve the best results. In this case, you might want to have a process where somebody leads on the Investment and Impact Fund for the network. They would be responsible at board level for overseeing the delivery.
Then in every practice we have somebody who is accountable to them for the delivery at practice level. So we’ve got a board lead and a practice lead and we can also identify anyone else in the practice that is going to actively help pursue the indicators.
In North West Leicestershire, they have built this accountability structure really well – they have ongoing analysis each month and they act on any shortfall. It’s just a great system.
They’re on track to deliver all the first priorities, all the second priorities and a few off the watch and wait list as well – all because they have a tight, slick process of ongoing review. They’re also going to introduce, at my suggestion, hour-long weekly operational meetings to check in on how the practices are going and step in if anyone’s got problems or needs help.
That’s an opportunity to have an ongoing dialogue with the member practices because they are big. They’ve got 12 member practices so it’s good to have a forum like that. We might also introduce a quarterly workshop agenda.
This is all common sense best practice and it works in other situations as well – regular meetings that keep everything on track, make sure nothing is missed and makes hitting objectives easier. It’s simple – as long as you make the time and space to keep on top of the process.
Fed up of pulling in different directions? I help GPs, PCNs, GP federations, and Integrated Care Systems tackle their communication and process challenges to build sustainable and resilient practices that produce better outcomes for all. If you’d like to find out more, schedule a call today.