Changes to the GP contract 2024/25: Implications for primary care networks – Budgeting, forecasting, and financial planning

The revised Primary Care Network (PCN) contract for the financial year 2024/25 brings forth transformative adjustments, emphasising efficiency, flexibility, and patient-centric care. In this insight article, we delve into the significance of budgeting and forecasting for both individual member practices and the PCN as a whole.

The baseline practice contract funding uplift well below-inflation 1.9%. This is clearly insufficient to cover the rise in costs already seen for Primary Care Networks (PCNs) or general practice, as a result we may see staff reductions and services reducing or closing altogether unless savings can be found.

The importance of PCNs is paramount with collective working across the network required to maximise efficiencies and ensure resources are allocated to where they are needed most.

Delays in providing clarity in the contract haven’t helped PCNs budget for 2024/25 and beyond, which impacts on the PCN and member practices who are being asked to improve care quality and patient access across the network while seeing their costs increase and their income failing to keep pace.

Cash flow for PCNs and member practices

Flexibility in funding is required to help practices and networks develop methods and systems to meet the needs of their patients. With this in mind the new contact has made a number of changes for 2024/25 to support this:

• To help improve practice cash flow, the QOF aspiration payment threshold will be raised from 70% to 80% in 2024/25, meaning a larger proportion of QOF is paid monthly.
• The Capacity and Access Payment (CAP) will increase by £46m to £292m by retiring three Investment and Impact Fund (IIF) indicators.
  As in 2023/24, 70% of the funding will be paid to PCNs without any conditions via the Capacity and Access Support Payment (CASP) proportionate to their Adjusted Population, in 12 equal payments. PCNs have the discretion to use the funding according to local needs – for example, the supervision of ARRS staff or to increase the care home premium within the PCN.
• As above, the remaining 30% of the Capacity and Access Payment (CAP) will be paid to PCNs via the Capacity and Access Improvement Payment (CAIP).
  To improve cashflow, this will be paid to PCNs at any point in the year in monthly instalments once the PCN Clinical Director (CD) confirms to their ICB that all practices within a PCN have put in place one or more of the three individual components of the Modern General Practice Access model, which each attract 1/3 of the overall CAIP funding.
• The Enhanced Access specification will remain as a separate specification with the arrangements unchanged in 2024/25, however, the remaining eight PCN service specifications will be replaced by one simpler overarching specification.
• The PCN Clinical Director role specification will be simplified by articulating the following key responsibilities: co-ordination of service delivery, allocation of resources, supporting transformation towards Modern General Practice and supporting the PCN role in developing Integrated Neighbourhood Teams.
• The PCN Clinical Director and PCN Leadership and Management Payment (£89m combined) will be rolled into core PCN funding to give £183m in total. This is intended to provide PCNs with greater autonomy and to allow PCN Clinical Directors to lead their PCN in the way that best suits local arrangements.

Why Budgeting Matters

Budgeting serves as the bedrock for financial stability and effective resource allocation within PCNs and member practices. Given the changes to funding and the focus on flexibility, PCNs and practices should be aware of how the budget impacts them, both from a cashflow point of view and with regard their network responsibilities. Here’s why it matters:

1. Resource Allocation: A well-structured budget allows PCNs and practices to allocate resources efficiently. It ensures that funds are directed toward essential services, staff salaries, infrastructure, and patient care.
2. Financial Planning: Budgets facilitate long-term planning. By forecasting income and expenses, practices can strategise for the future, anticipate challenges, and seize opportunities.
3. Transparency and clarity: Transparent budgeting fosters trust among PCN members. When everyone understands the financial landscape, collaboration becomes smoother. Providing financial clarity to the member practices ensures that they themselves can prepare their own budgets around the expected funding.

We have seen a shift in the way practices interact with their PCN and fellow members of the life of the 5 year plan, it’s become clear that PCNs are here to stay and practices are looking towards the future to develop new systems and methods within their area.

Initially, PCN funds were simply passed down to practices and decisions made at a local level, now we are seeing more discussions and decisions on the best use of those funds for the collective benefit of all stakeholders, patients, practices and the primary care network as a whole. Communication, budgeting and transparency are the keys to retaining trust and building confidence.

For more information, please contact Jay Gibson at jay.gibson@ballardsllp.com

Disclaimer. This article has been prepared for information purposes only. Formal professional advice is strongly recommended before making decisions on the topics discussed in this release. No responsibility for any loss to any person acting, or not acting, as a result of this release can be accepted by us, or any person affiliated with us.