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

2

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.

4

PCN development support offer

5

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:

7

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

8

02

Transforming London’s health and care together

Timeline for delivery

9

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

12

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

15