GP Contract Enhanced Services Primary Care Networks

The Network DES Investment and Impact Fund for 2020-21 explained

Elderly person receiving vaccination

Details of the revised Investment and Impact Fund for 2020/21 including the indicators have been published. Pulse Intelligence outlines how it will work.

The introduction of the Investment and Impact Fund (IIF) was previously postponed until 1 October, with £16.25m of the total £40.5m re-allocated to PCNs through the PCN support funding stream to help with the Covid-19 response.

The newly amended Network Contract DES introduces the remaining £24.25m funding, which PCNs have to earn by collectively delivering on a suite of QOF-like indicators.

As with QOF, each indicator is allocated a certain number of points which determine the relative allocation of funds.

For 2020/21:

  • Each IIF point will be worth £111
  • There is a total of 194 points available to each PCN
  • Payments to PCNs will be proportional to points earned, with an adjustment for list size and (where relevant) prevalence.
  • Performance is rewarded on a sliding scale between the lower and upper thresholds for each indicator.

The six indicators for 2020/21 represent key clinical priorities for PCNs in support of the recovery from the COVID-19 pandemic. 

The indicators are divided into two domains covering:

1. Prevention and tackling health inequalities – worth 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

The points, values and thresholds for each indicator are detailed in the table below.

Indicator descriptionValue – £mPointsLower ThresholdUpper Threshold
  % 65+ who received a seasonal flu vaccination    9     72  70%  77%
  % on Learning Disability register who received Learning Disability health check    5.875   47  49%  80%
  % referred to social prescribing    3.125  25  0.4%  0.8%
  % 65+ prescribed NSAID w/o gastro-protective    4  32  43%  30%
  % 18+ prescribed oral anticoagulant & antiplatelet w/o gastro-protective    0.75  6  40%  25%
  % 18+ prescribed aspirin & another anti-platelet w/o gastro-protective    1.5  12  42%  25%


For each indicator, a PCN’s achievement payment equals its achievement points multiplied by the value of the IIF point (£111.00), multiplied by a prevalence adjustment, multiplied by a list size adjustment. The value of an IIF point will be subject to annual revision.

The prevalence and list size adjustments should account for the varying effort required for different PCNs to make improvements in achievement.

The prevalence adjustment will be the PCN prevalence divided by the national average prevalence.

So where a PCN has, say, twice as many elderly patients as another, the prevalence adjustment means it gets paid more in recognition of the extra effort and resources required to vaccinate a certain percentage of them.

For example, if 30% of patients at a particular PCN are over 65 and nationally 20% are aged 65 and over, then its prevalence adjustment will be 1.5, ie, it will be paid 50% more for each additional IIF point than a PCN that has roughly the same proportion of elderly as the national average.

The list size adjustment is based on a similar principle. If two PCNs are the same, other than that one has double the list size, that PCN has to intervene with twice as many patients to earn the same number of points. The list size adjustment compensates larger PCNs for this situation by making the payment per achievement point proportional to list size. 

Specifically, the list size adjustment is equal to the PCN list size divided by the national average PCN list size. Thus, if the national average PCN list size is 47,000 and a PCN has 94,000 patients, that PCN’s list size adjustment would be 2. In other words, that PCN would be paid twice as much for each additional achievement point as an otherwise identical PCN with a list size equal to the national average.

PCNs will be able to monitor indicative performance against IIF indicators on a new online network dashboard, with performance available quarterly by PCN and constituent practice from autumn 2020.  

Further details about each indicator and the calculation of payment are included within the amended Network Contract DES and associated guidance.

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