Enhanced Services Primary Care Networks

How to tackle the updated Investment and Impact Fund targets for 2021/22

GP partner and PCN co-lead Dr David Coleman explains what the new Investment and Impact Fund indicators involve and how much they are worth, and offers tips on how to boost your Network’s achievement

The Investment and Impact Fund (IIF) is an incentive scheme operating at a PCN level. The goal is to encourage high level care for patients by rewarding achievement in a number of domains, which align to the priority objectives articulated in the NHS Long Term Plan and in Investment and Evolution; a five-year GP contract framework.

Launched during the second peak of the pandemic in October 2020, the initial iteration of IIF was understandably slimmed down, with a total of 194 points available at a value of £111 per point. 

Last year’s indicators focused on optimising social prescribing referrals, flu vaccinations in the elderly, learning disability reviews and safe prescribing. This year IIF has been scaled up with new indicators demonstrating a wider focus; the points available now total 225 and their value has increased to £200 per point.

The six new indicators have a combined national value of £50.7M. However the funding commitment for the IIF for 2021/22 is £150m. That leaves a shortfall of just under £100m, which will be likely be allocated in October 2021 attached to new indicators. This emphasises the importance of getting up to speed with the current IIF indicators now, as a lot more will almost certainly follow. It’s interesting to note that the prescribing indicators appear to have been shelved in the first wave of new indicators; I would anticipate, given that most PCN ARRS workforces include pharmacists, that these will return in one form or another from October onwards.

Prevention and tackling health inequalities domain

A PCN is able to earn up to 178 points in this domain. Of these, 142 points are related to performance on flu vaccination which has been expanded to three indicators to reward coverage in the elderly, clinical risk groups and children aged 2-3 years (compared with 72 points just for the elderly group last year).

While the amount of points available is higher, it is also worth pointing out that the thresholds are higher too.

Last year’s lower threshold for achievement in the 65 and over age group was 70%; this year it is 80%.  Furthermore, there are new thresholds for under 65s with underlying conditions and children – both with challenging lower achievement thresholds of 57% and 45% respectively.

A focus on delivery of annual learning disability reviews remains, with 36 points dedicated to it. The thresholds remain the same for this indicator (49% to 80%). It’s worth noting that a health action plan is now required in addition to the annual review, which will likely mean more time is required to complete this work.

Providing high quality care domain

A PCN is able to earn up to 47 points in this domain, which includes two indicators. 

The first is a reprisal of last year’s social prescribing referral indicator, although the lower threshold has doubled from 0.4% to 0.8%, while the upper threshold has increased to 1.2% of the PCN population. That equates to 600 referrals a year for a PCN of 50,000.

This represents a significant increase in workload for an indicator that many PCNs may have struggled with last year. PCNs will have to look at social prescribing capacity, and critically at how they document and code referrals, if they want to secure the 20 points on offer.

The second is a new indicator and is access related, with 27 points on offer. The specific wording for the indicator is: ‘Confirmation that, by 30 June 2021, all practices in the PCN have mapped all active appointment slot types to the new set of national appointment categories, and are complying with the August 2020 guidance on recording of appointments.’

There is a tight timeline for this and it may be a challenge for PCNs to bring every member practice along with them on this journey, especially with current workload and workforce pressures being what they are.

How much is the IIF worth to your PCN?

As stated above, the value of each of the 225 points is £200, but this is adjusted for PCN size and disease prevalence.  An average PCN of around 50,000 may expect to earn around £45,000, which will be split between in-year and end-of-year payments.  There is more detail on the payment process here.

It is worth noting, too, that the guidance document states that ‘the PCN must provide a written commitment to their commissioner that any money earned through achievement payments will be reinvested into additional workforce, additional primary medical services, and/or other areas of investment in a Core Network Practice that will support patient care (eg, equipment or premises)’.

That’s a wide remit, and has expanded a little from last year’s guidance. My interpretation is that there is a little more flexibility to use the money as the PCN feels appropriate here.

How can PCNs boost their achievement?

Flu vaccination is a huge area. We’ve all pulled together and done amazing things with the COVID vaccination campaign; it will be useful to learn the lessons from this. 

For example, what worked well in terms of hard to reach groups? Were roving teams effective for care homes and housebound populations?  What role can ARRS staff play in reducing pressures on primary care staff?

We have historically struggled with childhood flu vaccinations in our locality, so we are also looking at ways relationships might be developed with other local services. The indicator focuses on 2 and 3 year olds, so liaison with nurseries/pre-schools, health visitors, and playgroups may be of benefit.

Last year we maximised achievement on the learning disability reviews by putting our newly appointed ARRS care co-ordinators at the PCN in charge. This has taken pressure of practices and will provide an ongoing sense of continuity and uniformity. We are using the same templates across our PCN to facilitate data capture and are investing in our ARRS staff to create a learning disability cluster to perform the reviews; this will include a paramedic, a pharmacist and a mental health practitioner.

The access domain will be tricky to achieve. There is detailed guidance available here, but in summary there are 17 standardised types of ‘care related encounters’ (appointments/triage slots), three standardised ‘care related activities’ (activity that is about but not with the patient, eg, insurance reports and signing prescriptions), and six ‘administration and practice staff activity’ (admin work and staff related activity, eg, supervision). All practices currently use different, customised slots for their appointments; the vision is for us all to the use the same slots to facilitate more accurate tracking of national activity and workload in general practice. This requires communication and a degree of positivity; individually it may feel like a huge problem, but it seems we will just have to grasp the nettle on this one, so better now than during a potential further COVID wave in the late summer/autumn.

Social prescribing is an area that we struggled with. We are monitoring performance (via the NHS dashboard) and feeding back to practices, particularly to outliers. We have invested in our social prescribing workforce, reduced barriers to referral (a simplified referral process rather than a lengthy form) and encouraged other ARRS staff to refer patients to the service themselves, rather than pass back to GPs.

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

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