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Evolution of the PCN and Federation Models

Before the COVID-19 pandemic, we were seeing an increasing number of our clients looking to explore corporate models for their PCN. As we begin to refocus on the PCN landscape, we have seen this interest continue to grow.

Ruth Griffiths
Hill Dickinson

What is driving the move to incorporate?

Clients speak of a desire to take back control and to start ‘getting things done’. Having been brought together in the response to COVID-19, many Networks are keen to become independent and autonomous of previous hosted employment solutions that in the past had been perceived as a means of limiting liability when recruiting additional roles. Others have felt that they have gone as far as they can with the flat model and need a more
robust and sustainable model to meet the growing demands on PCNs.

With many practices still reluctant to take on the role of lead, a PCN Limited model can offer practices the solution they are looking for.

What does PCN Limited offer?

  • Limited liability – by creating a separate legal entity distinct from practices, the PCN Limited model can offer practices protection from liability not available through unincorporated form.
  • Workforce Solution – the corporate entity can employ, removing the need for a practice to
  • volunteer as lead or allowing the PCN to move away from the sometimes cumbersome flat or shared models of employment.
  • Pensions Access – previously perceived as one of the main obstacles to the company model, NHS BSA guidance released in October 2019 indicated that a company employing staff to perform Network activities may be eligible to apply for temporary NHS Direction/Determination status. While previously only temporary until 2021, we understand that this access is being extended and will be placed on a permanent footing to ensure that pension access will not be a barrier to the development of PCN models.
  • VAT Cost Sharing Group – pushing the non-clinical ask of PCNs into a company can give rise to VAT liabilities. With the correct advice, however, your PCN Limited model can form a cost-sharing group enabling services to be provided at costs to practice exempt from VAT.

Phased approach to PCN Limited

Many of the PCNs we work with have moved to PCN Limited in phases – Phase One being an immediate solution for workforce before looking ahead to the transition of clinical services delivery into PCN Limited and associated CQC registration.

From Federation to Network of Networks – a solution now for PCNs and positioning for the longer term plan

The solution afforded by PCN Limited can be achieved in many cases through existing Federation vehicles. However, this may not be a viable option in your locality.

The focus on PCNs in the NHS Long Term Plan has left many federations at a cross-roads. What is clear, however, is that, as we look to a shift towards strategic commissioning and funding at ICS level, the need for a place-based voice and vehicle for primary care has rarely been greater. We have supported numerous federations – new and old – as they transition to a Network of Network model: primary care organisations across Place that are aligned and engaged with PCNs and their governance.

With limited resource for management coming through the DES, we need to ensure that the governance of PCNs and place-based primary care organisations are aligned to facilitate a strong and unified primary care voice in the system for the future.

PCC works closely with Hill Dickinson to support PCNs. Contact enquiries@pcc-cic.org.uk for more details.