Primary Care Network Workforce - 31 March 2020

Instigated as part of the NHS long-term plan, Primary Care Networks (PCNs) were created to provide accessible and integrated primary, mental health, and community care for patients. Serving patient populations of between 30,000 and 50,000, these PCNs should be small enough to deliver a personal service and continuity of care, yet large enough to take full advantage of the benefits of working closely with – and sharing resources between – GP practices and other organisations in the local community. Although GP practices retain their individual contracts and responsibilities, the PCNs will build on these, working collaboratively with other health, social care, mental health, and voluntary partners to deliver additional services that cannot be provided on a smaller scale.

There are many anticipated benefits to the PCNs, including providing patient access to specialist health professionals – employed across the PCN as a whole – whose skills would otherwise not be available to patients in the local area.

The PCN contract was introduced 1 July 2019 as a Directed Enhanced Service and initially aimed to fund 20,000 additional health and care professionals, to strengthen primary care, improve community-based care and reduce the need for hospital treatment.

Since July 2019, most GP practices have joined with other practices and care providers in their local area to form one of around 1250 Primary Care Networks.

Membership of a PCN it is not mandatory and some practices have chosen not to join. It is also possible that practices with a large enough patient list-size could function as a PCN in their own right. At the end of March 2020, 34 PCNs had a single GP practice in their membership while the largest PCN, which also catered for the greatest number of registered patients, had 33 GP practices in its network.

Although most PCNs cater for a minimum of 30,000 registered patients, some rural PCNs will have smaller populations or cover large geographical areas which cater for a widely dispersed population. Conversely, some other PCNs will have large patient populations, far exceeding 50,000 patients. On 31 March 2020, on average the registered patient population count for a PCN was just over 48,000, with the smallest catering to fewer than 15,000 patients while the largest was responsible for almost 265,000.

PCNs are intended to cover 100% of the resident population in England and, in general, groups of PCNs can often be considered to align to CCG boundaries (figure 4). In most PCNs, the GP practice members are from the same CCG although there are a few exceptions, notably where practices were already working in networks that cross CCG boundaries (figure 5).

In addition, the GP practice members are not necessarily immediate neighbours meaning a PCN’s geographical coverage may consist of several non-adjacent areas (figure 6).

Similarly, PCN responsibilities may be considered in terms of the locations of their registered patients (figure 7), and as GP practice patient catchment areas can overlap and may cross CCG boundaries, the geographical coverage of PCNs is further complicated.

There are therefore two different ways in which PCNs may be considered:

• As a cluster of GP practices and other organisations jointly employing a pool of staff that can be deployed across the PCN
• As the broad geographical entity covered by the collection of GP practices as defined by their patient catchment areas which may overlap with practices aligned to other PCNs

This publication relates solely to the workforce directly accountable to the PCN and contains no information about GP practices or their staff. However, information about the GP practice workforce is published in a separate series of Official Statistics which is available from https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services and now includes details of GP Practice staff within a PCN footprint.

The NHS Long Term Plan committed additional funding for primary medical and community health services for five years from 2019/20, and initially aimed to recruit and retain an extra 20,000 health and care professionals. These additional workers will deliver a broad range of provision in accordance with the service specifications, and it is expected that they will provide tailored care to patients, thereby freeing GP capacity to focus on those with more complex needs.

The PCN workforce is separate and distinct from the GP practice workforce although some individuals may work part-time in both types of organisation. Furthermore, some PCN staff may work for other organisations either as PCN members or separate entities – such as mental health services, charities, or social care providers – in addition to their PCN-based hours. It is possible that the working hours of these individuals may be counted not only in this report, but also against their employing organisation and as a result, figures on the PCN and GP practice workforce publications should not be summed to infer anything about the overall NHS workforce. For example, it is possible that some clinical pharmacists working for a PCN may actually be employed by an NHS trust. Depending on how data are coded, information about these clinical pharmacists may be included in published figures relating NHS hospital staff as well as being reported in the PCN totals. Social prescribing link workers are likely to be employed by local authorities or other third-party bodies, even though they too are deployed to the PCN to fulfil contracted services. Please refer to the data quality section for further details.

The PCNs are led by a named and accountable clinical director, although the role and responsibilities may be shared by several named and suitably qualified people. The clinical directors tend to be GPs, nurses, clinical pharmacists or other healthcare practitioners, and their workload and funding is expected to be on a sliding scale depending on the size of the network. For example, it is anticipated that the clinical director’s workload commitment for a PCN with 50,000 registered patients would equate to 0.25 full-time equivalence.

The PCN workforce comes from a range of organisations. Some staff have transferred from a GP practice and now work across the entire network. In these cases, the staff member may have transferred all their working hours to the PCN while in other situations, their time may be split between their PCN and the original GP practice. As a result, it is possible that full-time equivalence counts in the general practice workforce may decrease slightly as staff join the PCNs. This includes a potential reduction in full-time equivalent (FTE) GP and nurse counts because although PCNs do not employ GPs or nurses, some may be working part-time in the PCN in clinical director roles. Please refer to the data quality section for more information about full-time equivalent figures.

In addition to former GP practice staff, the PCN workforce will encompass colleagues from other health, social care, mental health and voluntary partners and it is expected that the PCN workforce will grow over time. Targeted PCN funding, under the Additional Roles Reimbursement Scheme (ARRS), focused on the recruitment of clinical pharmacists and social prescribing link workers during the first financial year (2019/20). These were to be followed by first contact physiotherapists and physician associates in 2020/21 and paramedics during 2021/22. However, a revision to the contract early in 2020 expanded the roles to be funded under ARRS to include six additional roles for 2020/21 covering a further 6,000 professionals. 

Each PCN has the autonomy to determine which roles to provide and to agree the job descriptions, so although the national goal is now to increase the primary care workforce by an additional 26,000 health and care professionals, the number of staff for each role that a PCN should employ is not specified. However, the number of pharmacy technician and first contact physiotherapist posts that are eligible for funding is limited to one of each post per 99,999 registered patients, increasing to a maximum of two where there are high numbers of registered patients.

While the aspiration is to recruit 26,000 additional staff, some clinical pharmacists and pharmacy technicians, originally funded under the Clinical Pharmacist General Practice Scheme or the Medicines Optimisation in Care Home Scheme will simply transfer into PCNs. However, any posts not funded under these schemes, and the other posts listed in Table 1 must be staffed as new appointments rather than staff transfers to qualify for ARRS funding.

In addition to the health and care professionals, the PCN will also employ some administrative staff to provide necessary support.

People working for the PCN may be employed in a variety of ways depending on each PCN’s governance arrangements.

Details about the PCN workforce are recorded in the National Workforce Reporting System (NWRS) which is also the system used to collect information about the GP practice workforce. More information about the NWRS is available at https://digital.nhs.uk/data-and-information/areas-of-interest/workforce/national-workforce-reporting-system-nwrs-workforce-census-module.

• In some cases, staff are named individuals who work solely for the PCN. These may be individuals newly recruited to the PCN, or staff transferring some or all of their working hours from a GP practice or elsewhere.
   
• Alternatively, the individual may be directly employed by a member organisation of the PCN – such as a hospital trust or charity – and deployed to the PCN and their details, including working hours for the PCN, are recorded in the NWRS. In these cases, the individual’s employer is reimbursed for the staff costs under the ARRS.
   
• For some PCNs, a role – for example a physiotherapist – may not be permanently staffed by a single individual. Instead, the working hours are covered by a group of physiotherapists, sometimes referred to as “pooled resource”, employed by another organisation such as the local CCG, and deployed to the PCN. In these cases, the providing organisation holds a contract with the PCN to deliver the physiotherapy service and supplies appropriately qualified staff, possibly on a rota’d basis.
  This means the NWRS collects information relating only to the average weekly working hours covered by that role or pooled resource, rather than capturing information about individuals, their working patterns, and personal details such as age, gender or start dates. In such cases, although proxy FTE figures for the staff deployed to the PCN can be produced, no information about headcount or workforce characteristics can be inferred.