A local variation to the primary care network (PCN) contract will unlock £10 million to support patients with the most complex needs, health leaders have said.
NHS England has approved a variation to the PCN direct enhanced service (DES) contract developed jointly by Kent and Medway integrated care board (ICB) and GP representatives from Kent Local Medical Committee (LMC),
The move comes after NHS England announced last month that the DES had been updated to enable ICBs to request local variations to allow contracts to be tailored to specific needs.
Kent and Medway ICB said its local contract variation is the first of its kind nationally, and it will deliver ‘GP-led single neighbourhood care’ through existing PCN arrangements.
The ICB said the variation aims to support general practice to lead new single neighbourhood arrangements, focused on improving outcomes for people with the most complex health needs.
It will reduce fragmentation, simplify arrangements, strengthen continuity of care and unlock nearly £10 million of new annual investment to support patients.
Chair of Kent LMC Dr Gaurav Gupta said the variation will put ‘list-based general practice at the heart of neighbourhood health in the county’.
‘We have agreed meaningful new investment into general practice to deliver evidence-based care to our most vulnerable patients,’ he said.
‘This single neighbourhood model will allow practices and primary care networks to build upon the good work they are already doing, further improving outcomes for our communities.’
The focus of the new neighbourhood model will be on the 92,000 patients in the most complex care cohorts, including care home residents, people on palliative care registers and housebound patients living with severe frailty.
Under the contract variation GPs will provide these patients with proactive interventions such as advance care planning discussions, comprehensive geriatric assessments, and structured medication reviews.
Kent and Medway ICB said that while this patient group represents around 5% of its population, they account for around 30% of hospital admissions and often experience longer hospital stays.
It added that extended stays can lead to deconditioning and worsening frailty and by providing ‘proactive, wraparound’ care at patients’ homes or residences the model hopes to improve outcomes and reduce unnecessary hospital admissions.
Chief executive of NHS Kent and Medway Adam Doyle said that as ICBs take on a stronger strategic commissioning role they need to start where they can have the biggest impact.
Mr Doyle added: ‘We recognise that to make improvements in Kent and Medway we need to do real transformation and have been working with partners across and outside of the NHS to understand how we might make the shift.
‘We have had strong support across the system to change the way we do things within our four layers of care in which general practice is a significant part.
‘We have been working with stakeholders on the model we want to embed, to bring care closer to people’s homes.
‘As ICBs take on a stronger strategic commissioning role, we think we should be brave and start that process where we know it can make the most difference to people’s experience of healthcare and the outcomes they experience.’
Practices taking up the contract will build on the clinically-agreed model developed with partners across the NHS system, as well as evidence-based interventions already proven through local schemes.
The ICB confirmed that, for practices choosing to take part, the level of investment offered will be considered a ‘minimum floor for future funding’.
