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Additional roles reimbursement scheme – new workforce, new challenges

If primary care networks fail, the long-term plan will also fail. To succeed, PCNs need to get the workforce right. That means more staff in a wider variety of roles.

NHS England has recognised this by developing a five-year directed enhanced service (DES) payment scheme for PCNs, which are being encouraged to expand their workforce beyond the traditional practice-based roles.

During a webinar, Amy Millson, a legal director in employment at Hill Dickinson, explained: “The DES funding will allow practices to share clinicians such as pharmacists, physiotherapists, physician associates, paramedics and social prescribers.

“PCNs that were established by 1 July this year will receive funding for those additional clinicians through to 2024.”

However, she cautioned, the changes come with challenges – including questions around employer liability, clinical management and access to the NHS pension scheme.

All such issues, including agreement about the day-to-day management of additional staff, should be covered in a network agreement complete with a workforce schedule. The employment contracts that networks use may also depend on the PCN structure they have adopted.

Issues may arise after new staff are in place. These include the risk of creating a two-tier workforce with different line management arrangements, policies and procedures. Such inconsistencies could expose PCNs and member practices to claims of discrimination.

Emphasising the primacy of leadership, culture and integration, Millson said: “They are key to your practice but what happens when your practices come together? You and your partners will need to develop a leadership structure and strategy. They will decide how key decisions are reached. Do votes need to be unanimous or simple majority? Do all the partners in member practices have a vote or is it just one per practice?”

She also cautioned that unless NHS England extends the DES, PCNs will be faced with particular challenges in 2024 when retaining the additional clinicians/workforce from practices’ own funds may be unsustainable. At this point, redundancies may be necessary and consultation with the PCN workforce would be essential. Employment tribunal claims might also follow.