GP Contract Enhanced Services Primary Care Networks

How to meet the Investment and Impact Fund requirements – a guide for PCNs and practices

GP and PCN lead Dr David Coleman explains what the new Investment and Impact Fund involves and offers advice on how practices can best meet the goals to earn the maximum funding on offer

Revised details of the new achievement-based fund for Primary Care Networks (PCNs) were announced in September 2020.

The new start date for the Investment and Impact Fund (IIF) for 2020/21 was October 1st and it will run until March 31st. 

Think of the IIF as a kind of Quality and Outcome Framework (QOF) for Networks; according to the NHS England guidance document on the IIF, the general objective is to ‘support primary care networks (PCNs) to deliver high quality care to their population’ but this year there is a heavy focus on the COVID-19 response.

How much is it worth?

The document states that ‘the IIF will be worth £24.25 million in 2020/21, rising to at least £150 million in 2021/22, £225 million in 2022/23 and £300 million in 2023/24’.  So this is going to be a vital priority for PCNs for the foreseeable future.

Like QOF at a practice level, indicators are worth a number of points, with achievement being rewarded on a sliding scale between two thresholds. ‘Each PCN can earn a maximum of 194 IIF points and the value of a point will be £111.00 (adjusted for list size and prevalence)’.

This equates to £21,500 of IIF funding for an average PCN, which has to be reinvested ‘into additional workforce and/or primary medical services’.

What do practices have to focus on?

There are six indicators are divided into two key domains (thresholds detailed separately here):

  1. Prevention and tackling health inequalities (119 points)
  • Percentage of patients aged 65 and over who received a seasonal flu vaccination
  • Percentage of patients on the learning disability register aged 14 and over who received an annual learning disability health check 

2. Providing high quality care – personalised care and medicines safety (75 points)

  • Percentage of patients referred to social prescribing
  • Percentage of patients aged 65 and over currently prescribed a non-steroidal anti-inflammatory drug (NSAID) without a gastro-protective medicine
  • Percentage of patients aged 18 and over currently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant) and an antiplatelet without a gastro-protective medicine
  • Percentage of patients aged 18 and over currently prescribed aspirin and another antiplatelet without a gastro-protective medicine

Achievement is measured at a PCN level and progress can be monitored on a quarterly basis via a new digital dashboard.

With only 6 months to achieve the targets in 2020/21, the first quarterly check will be vital.

How should we approach the IIF?

Primary care is no stranger to incentivised targets and we are used to devising plans to achieve these at a practice level. 

The key difference here is working with our neighbours.  By now, PCN relationships should be well established. We may have differences in approaches, but a common ground will hopefully have been acknowledged. 

To me, it makes sense for the Clinical Director to adopt the role overseeing IIF, although local arrangements could be made to allow another interested party, say a GP or practice manager from a member practice, to lead on this area; a compromise could be to backfill their time with additional hours from the ARRS workforce.  The key is that the PCN should agree who will take responsibility.

As stated above, the critical point is maximising the initial and then the first quarter review of the data on the dashboard.

This will help the practices make the necessary push in these performance areas to maximise achievement.  I would suggest IIF becomes a standing agenda item at monthly PCN meetings to encourage all practices to keep an eye on the ball.

Here are some additional thoughts and advice on the specific indicators:

PR01: Percentage of patients aged 65 and over who received a seasonal flu vaccination

  • Flu should be a massive priority for PCNs and practices anyway. The QOF indicators have been remodelled to maximise its financial importance; through IIF, high achievement is rewarded again.  All Networks should have a clear flu plan and I would recommended weekly nudges regarding performance to ensure we all maintain our focus, especially with a potential COVID-19 vaccination programme on the near horizon. Don’t forget to code declines, too, as these make hitting the targets easier.

HI01: Percentage of patients on the learning disability register aged 14 and over who received an annual learning disability health check

  • Again, this should be another area of focus for practices. Annual reviews are already financially incensed through the DES, with a payment of £140 per review. In addition, they form part of the QOF QI module on Learning Disability. So again, this is basically another good reason to focus heavily on this vulnerable group. As a PCN, we are training up our newly recruited Physician Associates to carry out Learning Disability reviews for member practices.

It is advisable to make sure there is a joint focus on the QOF QI tasks when addressing the IIF work too – while there is some overlap, they are not the same.

PC01: Percentage of patients referred to social prescribing

  • The IFF document features some useful information regarding this. Essentially, the PCN needs to refer a target percentage of patients to the social prescribing service. The upper threshold to achieve maximum points of 0.8% is quite a significant proportion of patients and I am not sure our link worker could handle these numbers. It will be worth looking at your social prescribing service to see ways you can make the process as effective as possible.

Some resources are available from NHS England including guidance on introducing social prescribing link workers and on implementing a social prescribing service.

MS01, MS02, MS03: Gastro-protective prescribing

  • These focus on gastro-protective prescribing for patients on NSAIDs (one of last year’s QOF Quality Improvement focal points), DOACs and aspirin. This falls in the wheelhouse of the PCN pharmacists and will dovetail nicely with their Structured Medication Reviews embedded in a separate service specification. The thresholds seem quite reasonable and some shrewd searches and appropriate medication review templates should make this easy to address.  A network pharmacist could devise a safety questionnaire or shared decision making tool, which could be provided to patients via online consultation software, such as AccuRx or eConsult’s MJog to streamline the consultations.

In summary:

  • The funding is quite generous and we are doing a lot of this work anyway – so it is worth making sure the targets are addressed
  • Monitoring progress at baseline and at the halfway point will be key to making sure targets are hit
  • Make full use of ARRS workforce to achieve these targets
  • Have a named lead within the PCN – likely the director, but could be another interested party – and make sure the IIF work is a standing agenda item at meetings so everyone is aware of what needs to be done.
  • Social prescribing is probably the trickiest target to hit – make sure your service is fit for purpose and has the capacity to reach the upper threshold.

Dr David Coleman is a GP partner and PCN co-director in South Yorkshire

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