In October the PMS and GMS regulations were amended/updated to incorporate several changes.

The changes cover the following:

  • to require contractors to comply with requests for information and update their patient lists;
  • to alter the definition of "primary care network" to reflect that a primary care network might be approved with a minimum population of less than 30,000 people;
  • to update the guidance published by the Health and Social Care Information Centre (also known as NHS Digital) that will apply in relation to the data that must be recorded by contractors and submitted to the Centre;
  • to insert a new requirement for participation by contractors in the collection of data held by practices relating to all appointments for the provision of primary medical services;
  • to prevent a contractor deregistering a patient previously removed from another contractor's list because of violence, where that patient has participated in a violent patient scheme and has been discharged and hence is eligible to register with a contractor to receive primary medical services or where that patient has successfully appealed allocation to a violent patient scheme;
  • to clarify the circumstances in which a contractor can request the removal of a patient from its list by the Board, where a patient has moved out of its catchment area;
  • to amend the circumstances in which the Board can assign a new patient to a practice (where that person has been refused inclusion in a contractor's list or accepted as a temporary patient) to include a practice in whose clinical commissioning group area the person resides;
  • to allow the provisions for out-of-area registration to apply to a new patient who has been assigned to a practice by the Board in circumstances where that patient resides outside of a contractor's practice area but within the clinical commissioning group area of which it is a member, and the contractor elects to accept that patient as an out of area patient;
  • to provide an exception to the prohibition on a sub-contract permitting the sub-contracting of clinical services to provide that services provided under the Network Contract Directed Enhanced Service Scheme may be subcontracted by the sub-contractor provided the Board agrees; and
  • to add to the grounds for which the Board may give notice in writing to the contractor to terminate the contract to include where the contractor's registration with the Care Quality Commission has been cancelled.

Subcontracting the Network DES

Perhaps of most interest to PCNs will be the relaxation of the restrictions on 'double-subcontracting'. The PMS and GMS regulations allow subcontracting of clinical services either with the commissioner's approval (PMS) or following notification and no objection (GMS). However, in both cases the GMS and PMS regulations required any sub-contract to prohibit any further sub-contracting by the sub-contractor. The October amendment now permits a sub-contract to allow further sub-contracting specifically in relation to the Network Contract DES provided the commissioner's consent is obtained. The above will be particularly helpful for PCNs who intend to use more complex models of delivery - perhaps involving PCN companies or GP Federations.

One slight anomaly at the time of writing is that the APMS Directions 2020 (effective from October 2020) have not been updated to include this flexibility. PCNs which include an APMS contract holder and which intend to utilise a model involve 'double sub-contracting' should liaise with the commissioner to ensure that consent is available and obtained in writing.

The commissioner is required to update GMS Contracts and PMS Agreements to reflect the changes to the regulations and in due course, mandatory variations should be issued once published on NHS England's website.

VWV are pleased to offer a range of services to PCNs including:

  • Drafting, reviewing and advising on Network Agreement schedules
  • Drafting expense sharing agreements
  • Formation of PCN companies and tailored governance
  • Preparation of clinical and commercial subcontracts
  • Partnership Agreement variations to reflect PCN membership and interests in PCN companies

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.